Optimizing Guideline-Directed Medical Therapy for Heart Failure　― Challenges and Strategies ―

Onoue, Kenji

doi:10.1253/circj.cj-23-0828

Circ J

2023

DOI: 10.1253/circj.cj-23-0828

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Optimizing Guideline-Directed Medical Therapy for Heart Failure　― Challenges and Strategies ―

Kenji Onoue

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2024

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Optimizing Guideline-Directed Medical Therapy During Hospitalization Improves Prognosis in Patients With Worsening Heart Failure Requiring Readmissions

Matsukawa,

Kabu,

Koga

et al. 2024

Circ J

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Background: We previously demonstrated that higher simple guideline-directed medical therapy (GDMT) scores (comprising renin-angiotensin system inhibitors, β-blockers, mineralocorticoid antagonists, and sodium-glucose cotransporter 2 inhibitors) at discharge were correlated with improved prognosis in heart failure (HF) patients. HF readmissions are linked to adverse outcomes, emphasizing the need for enhanced optimization of GDMT. Methods and Results:Using the simple GDMT score, we evaluated the effect of revising and modifying in-hospital GDMT on the prognosis of patients with HF readmissions. In this retrospective analysis of 2,100 HF patients, we concentrated on 1,222 patients with HF with reduced ejection/moderately reduced ejection fraction, excluding patients with HF with preserved ejection fraction, on dialysis, or who died in hospital. A higher current GDMT score was associated with better HF prognosis. Of the 1,222 patients in the study, we analyzed 372 cases of rehospitalization, calculating the simple GDMT scores at admission and discharge. Patients were divided into groups according to score improvement. Multivariate analysis showed a significant association between improved in-hospital simple GDMT score and the composite outcome (HF readmission+all-cause mortality; hazard ratio 0.459; 95% confidence interval 0.257-0.820; P=0.008). Even after propensity score matching to adjust for background, among rehospitalized patients, those with an improved in-hospital simple GDMT score had a better prognosis. Conclusions:Our results highlight the potential of robust interventions and score elevation during hospitalization leading to improved outcomes.

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Optimizing Guideline-Directed Medical Therapy During Hospitalization Improves Prognosis in Patients With Worsening Heart Failure Requiring Readmissions

Matsukawa,

Kabu,

Koga

et al. 2024

Circ J

View full text Add to dashboard Cite

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Optimizing Guideline-Directed Medical Therapy for Heart Failure　― Challenges and Strategies ―

Cited by 1 publication

References 10 publications

Optimizing Guideline-Directed Medical Therapy During Hospitalization Improves Prognosis in Patients With Worsening Heart Failure Requiring Readmissions

Optimizing Guideline-Directed Medical Therapy During Hospitalization Improves Prognosis in Patients With Worsening Heart Failure Requiring Readmissions

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Optimizing Guideline-Directed Medical Therapy for Heart Failure ― Challenges and Strategies ―

Cited by 1 publication

References 10 publications

Optimizing Guideline-Directed Medical Therapy During Hospitalization Improves Prognosis in Patients With Worsening Heart Failure Requiring Readmissions

Optimizing Guideline-Directed Medical Therapy During Hospitalization Improves Prognosis in Patients With Worsening Heart Failure Requiring Readmissions

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Optimizing Guideline-Directed Medical Therapy for Heart Failure　― Challenges and Strategies ―