Post-decongestion right heart catheterization is associated with GDMT optimization and improved outcomes in patients hospitalized for acute heart failure
K Ishimaru, R Matsukawa, T Hashimoto, S Matsushima, K Misumi, T Fujino, S Keisuke, M Fujiwara, A Ishikita, H Kisanuki, M Tokumoto, T Yoshitake, K Ikuta, G Taniguchi, K AbeAbstract
Background
Initiating guideline-directed medical therapy (GDMT) during hospitalization for acute heart failure (AHF) remains challenging, particularly regarding the optimal timing and appropriateness of up-titration. Right heart catheterization (RHC) performed after decongestion provides detailed hemodynamic information; however, whether it facilitates GDMT optimization and improves clinical outcomes has not been well established.
Methods
We analyzed 1,625 patients with AHF enrolled in the multicenter retrospective registry “QHEART-R” between October 2020 and December 2024. We excluded patients with HFpEF, in-hospital death, dialysis, or loss to follow-up. Patients were categorized by whether they underwent RHC after decongestion (RHC group; n=731) or not (no-RHC group; n=894). Propensity score matching was performed to balance baseline characteristics (485 matched pairs). GDMT optimization was assessed using the Simple GDMT score.
Results
In the matched cohort, the RHC group had a higher Simple GDMT score than the no-RHC group (6.1±2.3 vs. 5.2±2.6, p<0.001) and a higher initiation rate of all four foundational therapies (“four pillars”) (49.1% vs. 34.2%, p<0.001). The composite endpoint of all-cause death or hospitalization for heart failure was lower in the RHC group (hazard ratio 0.63, 95% CI 0.485–0.819; p<0.001).
Conclusions
Among patients hospitalized for AHF, post-decongestion RHC was associated with greater GDMT optimization and improved clinical outcomes.abstract figure