DOI: 10.1161/circ.148.suppl_1.13958 ISSN: 0009-7322

Abstract 13958: A Novel Approach to Quantifying Guideline-Directed Medical Therapy Accounting for Treatment Intensity

Mirza S Khan, Charles F Sherrod, Philip G Jones, Gregg C Fonarow, Javed Butler, Adam D Devore, Paul S Chan, John A Spertus
  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

Introduction: Measuring the intensity of guideline-directed medical therapy (GDMT) is foundational for improving care in heart failure (HF). Existing measures either discount dose intensity or use inconsistent weighting.

Methods: The primary aims were to create the Kansas City Medical Optimization (KCMO) score, an interpretable GDMT score customizable to individual patients’ treatment eligibility, and to compare KCMO score distributions with the HF Collaboratory (HFC) and modified HFC scores in the CHAMP-HF registry. KCMO is the average of total daily to target dose percentages for eligible GDMT drug classes, reflecting the percent of optimal GDMT prescribed (range 0-100%). The HFC and modified HFC scores transform total daily to target dose percentages into points: 0 if none, 1 if < 50%, 2 if ≥ 50%, or (HFC only) set points for MRA (2) or ARNI (3) if on any dose. In the CHAMP-HF registry, we computed KCMO, HFC (range 0-7), and modified HFC (range 0-100) scores for each patient at baseline and 1-yr change from baseline for the 3 established GDMT therapies at the time (MRA, BB, and ACEI/ARB/ARNI). We compared baseline and change score distributions and the coefficient of variation (CV) across scores.

Results: At baseline (n = 4,532), the mean KCMO, HFC, and modified HFC scores were 37.0 (SD 25.0), 3.4 (1.6), and 38.7 (18.3), respectively. Of those with data at yr 1 (n = 4,061), mean change from baseline for the KCMO, HFC, and modified HFC scores were -1.67 (17.7), -0.10 (1.31), and -1.98 (15.1), respectively. Baseline CV was highest for KCMO (0.68) indicating greater variability around the mean and more sensitivity than HFC (0.48) and modified HFC (0.47) scores.

Conclusion: The KCMO score measures GDMT intensity incorporating dosing and treatment eligibility, provides more granularity than existing methods, has clear interpretability, and can be adapted as performance measures evolve. Further study of its association with outcomes and usefulness for quality improvement are needed.

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