Early initiation of quadruple GDMT within 48 hours in HFrEF ADHF patients reduced in-hospital mortality by 73% (RR 0.27) and quadrupled GDMT continuation at discharge.
Does early initiation of quadruple guideline-directed medical therapy within 48 hours of admission reduce in-hospital mortality in patients with HFrEF hospitalized for acute decompensated heart failure?
Initiating quadruple guideline-directed medical therapy within 48 hours of admission for acute decompensated HFrEF is associated with significantly lower in-hospital mortality and higher rates of GDMT continuation at discharge.
Absolute Event Rate: 0% vs 0%
Abstract Background Heart failure (HF) presents a significant global health burden, with acute decompensated heart failure (ADHF) leading to high hospitalization rates and poor outcomes. Despite advances in guideline-directed medical therapy (GDMT), the optimal timing of its initiation during acute decompensated heart failure (ADHF) remains a matter of debate. Purpose This study aims to explore the impact of early initiation of quadruple HF therapy within 48 hours of ADHF hospitalization in HFrEF patients. Methods This propensity score-matched analysis utilized data from the ICARUS registry, including HFrEF patients hospitalized for ADHF between June 2022 and March 2024. Early quadruple therapy was defined as a prescription of beta-blockers, ACEi/ARB/ARNI, MRAs, and SGLT2i within 48 hours of admission. The propensity score matching used the optimal full matching method, while generalized linear models with a logit link function were used to estimate treatment effects, adjusting for residual imbalances. The primary outcome was in-hospital mortality, with secondary outcomes including factors associated with early GDMT initiation and GDMT prescription rates at discharge. Results From 3402 admissions for ADHF in the ICARUS registry, 2051 patients with HFrEF were analyzed. Of these, 898 (43.8%) received early quadruple GDMT within 48 hours of admission. Prescription rates varied by drug class: beta-blockers (89.4%), ACEI/ARB/ARNI (71.9%), MRAs (68.3%), and SGLT2i (63.9%). Independent predictors of early quadruple therapy included higher glomerular filtration rate, prior aldosterone antagonist use, and higher MLHFQ scores, while female sex, higher ejection fraction, and frailty scores were negative predictors. After propensity score matching, early quadruple therapy was associated with a 73% reduction in-hospital mortality (RR 0.27; 95% CI 0.14-0.53, p 0.001) and higher rates of continuation of GDMT at discharge, nearly quadrupling the chances compared to patients who did not receive it (RR 3.82; 95% CI 3.01-4.86). Conclusion(s) In patients with HFrEF hospitalized for ADHF, early initiation of quadruple GDMT within 48 hours of admission significantly enhanced in-hospital outcomes. Patients who received early quadruple therapy experienced a 73% reduction in the risk of in-hospital mortality compared to those who did not. Additionally, early therapy nearly quadrupled the likelihood of continuing GDMT at discharge.Results of Early Quadruple GDMT in ADHF
Echeverria et al. (Sat,) reported a other. Early initiation of quadruple GDMT within 48 hours in HFrEF ADHF patients reduced in-hospital mortality by 73% (RR 0.27) and quadrupled GDMT continuation at discharge.