Impact of simple GDMT score on prognosis in heart failure patients with cardio-renal anemia syndrome: insights from QHEART study
M Tokumoto, S Matsushima, R Matsukawa, H Kisanuki, G Taniguchi, K Misumi, T Fujino, K Shinohara, T Hashimoto, K AbeAbstract
Background
A simple guideline-directed medical therapy (GDMT) score of ≥5, calculated by the combination of GDMT drugs (renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium-glucose transporter 2 inhibitors), is associated with prognosis in heart failure with reduced and mildly reduce ejection fraction (HFrEF and HFmrEF). HF patients often complicated Cardio-Renal Anemia Syndrome (CRAS). In addition, the instrument of GDMT for patients with CRAS is often challenging. In addition, its impact of simple GDMT score on prognosis in patients with Cardio-Renal Anemia Syndrome (CRAS) is unclear.
Purpose
This study aimed to investigate the association between the simple GDMT score and the one-year prognosis of patients HF and CRAS.
Methods
We analyzed 1,615 HFrEF and HFmrEF patients in QHEART study, a retrospective registry of HF patients admitted to 6 hospitals, including Kyushu university hospital, from October, 2020 to December, 2024. Renal dysfunction (RD) was defined as eGFR<60mL/min/1.73m2 and anemia was defined as Hb<13.0g/dL in males, <12.0g/dL in females. The composite outcome of all-cause death or HF admission during 1 year after discharge was evaluated according to simple GDMT score of ≥5 or less by Cox multivariable analysis.
Results
We divided these patients into four groups according to the presence/absence of RD and/or anemia; Group 1: RD(-)/anemia(-) (245), Group 2: RD (1,232), Group 3: anemia (814), Group 4: RD(+)/anemia(+) (676). In Group 1, the composite outcome was comparable between patients with simple GDMT score of ≥5 and those of ≤4 (adjusted hazard ratio [aHR]:0.940, 95% confidence interval [CI]:0.408-2.167, p=0.88). On the other hand, the composite outcome was better in patients with simple GDMT score of ≥5 than those of ≤4 in Group2 (aHR:0.766, 95% CI:0.608-0.966, p=0.024). The same trends were observed in Group 3 (aHR:0.713, 95% CI:0.546-0.931, p=0.013) and Group 4 (aHR:0.736, 95% CI:0.553-0.978, p=0.035).
Conclusion
Simple GDMT score of ≥5 is associated with a better prognosis in HF patients with RD and/or anemia. Optimizing GDMT to reach this target may improve outcome in patients with CRAS.