Temporal Changes in Guideline-Directed Medical Therapy Score and Clinical Outcomes in Patients with Heart Failure
Toshifumi Tamura, Toshiyuki Nagai, Motoki Nakao, Yoshifumi Mizuguchi, Taro Koya, Atsushi Tada, Fusako George, Isao Yokota, Yoshiya Kato, Shogo Imagawa, Yusuke Tokuda, Masashige Takahashi, Junichi Matsumoto, Ko Motoi, Yutaka Wakamatsu, Masaharu Machida, Takahiko Saito, Toshihisa Anzai, , Toshifumi Tamura, Toshiyuki Nagai, Motoki Nakao, Shu Tahara, Yoshifumi Mizuguchi, Taro Koya, Atsushi Tada, Suguru Ishizaka, Hiroki Uehara, Makoto Kambayashi, Shota Saito, Ikumi Miyamoto, Yui Shimono, Fusako George, Toshihisa Anzai, Isao Yokota, Michito Murayama, Atsushi Shimizu, Yoichi Sutoh, Tsuyoshi Hachiya, Hideki Ohmomo, Seizo Koshiba, Mika Sakurai-Yageta, Masaru Obokata, Yusuke Tokuda, Shogo Imagawa, Naotaka Saito, Ichiro Yoshida, Yoshiya Kato, Masaharu Machida, Kosuke Nakamura, Ko Motoi, Junichi Matsumoto, Takahiko Saito, Shigeru Takechi, Noriyuki Miyamoto, Takayuki Hirabayashi, Eiichiro Imamura, Hisashi Yokoshiki, Takehiro Yamashita, Kazushige Kanki, Kazuyuki Noriyasu, Masashige Takahashi, Akinori Takahashi, Minoru Sato, Ichiro Sakuma, Masayuki Sakurai, Masahiko Obara, Yasumi Igarashi, Yutaka Wakamatsu, Yutaka Matsui, Hiroki NakanoAbstract
Aims
Optimisation of guideline-directed medical therapy (GDMT) is a cornerstone of management in heart failure (HF). The GDMT scoring system was developed to quantify both the use and intensification of GDMT. This study investigated the longitudinal changes in the GDMT score and its association with clinical outcomes in contemporary practice.
Methods and results
This multicentre prospective cohort study included 680 patients with chronic HF with reduced ejection fraction. The patients were classified into the up-titration (n = 282) and no up-titration (n = 398) groups according to changes in the GDMT score over 9 months. The GDMT score incorporated the use and dose of guideline-recommended drugs including quadruple therapy, ivabradine, and vericiguat. The primary outcome was a composite of all-cause death and hospitalisation for worsening HF. Inverse probability of treatment weighting was used to adjust for baseline differences. Up-titration rates at 9 months were 31.8% for renin–angiotensin system blockers, 28.2% for β-blockers, 10.6% for mineralocorticoid receptor antagonists, and 11.9% for sodium–glucose cotransporter 2 inhibitors. Up-titration was independently associated with baseline GDMT score, age, left ventricular ejection fraction, blood pressure, and renal function. Furthermore, up-titration was associated with a lower incidence of the primary outcome than no up-titration (adjusted HR, 0.65; 95% CI, 0.43–0.98).
Conclusion
In this contemporary chronic HF cohort, the GDMT score incorporating guideline-recommended drugs revealed suboptimal implementation and intensification of GDMT over 9 months. Greater increases in GDMT score were associated with improved clinical outcomes, supporting the clinical relevance of longitudinal GDMT optimisation.