Abstract 12163: Initiation of Guideline Directed Medical Therapy at Hospital Discharge Improves Outcomes in Heart Failure With Reduced Ejection Fraction

Background: HFrEF is associated with high morbidity and mortality. Current guidelines recommend early initiation of all GDMT, but critical gap exists in daily practice.

Research Questions: We aimed to demonstrate the benefits of initiating all GDMT at hospital discharge. We also investigated factors that caused the suboptimal prescription of GDMT.

Methods: This retrospective cohort study extracted data of all HFrEF patients admitted to a tertiary hospital in Taiwan from Jan. 2018 to Dec. 2019. Variables such as the date of mortality were collected by electronic medical records or by phone calls. Physicians would select a reason when patients were not given individual GDMT. Outcomes were analyzed according to the use of GDMT (0/1, 2, or 3-pillars).

Results: A total of 343 patients were included in the analysis. We found that patients receiving 3-pillars GDMT had significantly better outcomes; they had the lowest risk of 1-year cardiovascular death (3%) or 6-month heart failure hospitalization (5%), but they only accounts for 60 - 80% of patients in every quarter. The main factors that limited the proportion of patients receiving 3-pillars GDMT were the lower prescription rate of ACEIs/ARBs (80.8%) and MRAs (84.0%). In patients not using ACEIs/ARBs, most physicians were worried about renal impairment (71.2%) or hypotension (24.2%). Meanwhile, patients were not given MRAs due to renal impairment (69.1%) or because they were considered asymptomatic (27.8%). Analysis on the eGFR of patients not receiving optimal GDMT revealed that 60.9% of them had stage 3-4 CKD; only the addition of ACEIs/ARBs resulted in a nonsignificant eGFR drop of 3.5 ml/min/1.73m ² after 3 months.

Conclusions: This study confirmed the advantage of starting 3-pillars GDMT early in HFrEF patients. It also revealed the underutilization of GDMT due to concerns of worsening renal function. Efforts should be made to address this disparity to improve the care of HFrEF patients in Taiwan