Abstract
There are limited reports on the prevalence and clinical significance of guideline-directed medical therapy (GDMT) initiation in patients with acute heart failure (HF). We analyzed 2086 patients with acute heart failure with reduced or mildly reduced ejection fraction (HFrEF or HFmrEF) in the KCHF registry. The patients were classified according to the number of GDMT classes at discharge. The primary outcome was a composite of all-cause death or HF hospitalization. There were 181 (8.7%), 508 (24.4%), 791 (37.9%), and 606 (29.1%) patients with GDMT = 0, 1, 2, and 3, respectively. Current smoker, ambulatory status, and HFrEF were associated with full GDMT, whereas age ≥ 80 years old, acute coronary syndrome, anemia, and eGFR < 30 mL/min/1.73m2 were associated with absence of full GDMT. The cumulative 1-year incidence of the primary outcome was 56.3%, 40.7%, 31.9%, and 25.1% with GDMT = 0, 1, 2, and 3, respectively. The excess adjusted risk of patients with GDMT = 0 or 1, but not GDMT = 2 relative to those of GDMT = 3 remained significant for the primary outcome (HR 2.16 [1.66–2.82], 1.33 [1.07–1.66], and 1.03 [0.84–1.27]). Collectively, the greater number of GDMT classes at discharge was associated with a lower risk for all-cause death or HF hospitalization in patients with HFrEF or HFmrEF.
(200 words)
Data availability
The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
Abbreviations
- ACE:
-
Angiotensin-converting enzyme
- ARB:
-
Angiotensin receptor blocker
- ARNI:
-
Angiotensin receptor neprilysin inhibitor
- BB:
-
Beta blocker
- GDMT:
-
Guideline-directed medical therapy
- HF:
-
Heart failure
- HFmrEF:
-
Heart failure with mildly reduced ejection fraction
- HFpEF:
-
Heart failure with preserved ejection fraction
- HFrEF:
-
Heart failure with reduced ejection fraction
- KCHF:
-
Kyoto Congestive Heart Failure
- MRA:
-
Mineralocorticoid receptor antagonist
- SGLT2:
-
Sodium-glucose cotransporter 2
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Funding
This study was supported by grant 18059186 from the Japan Agency for Medical Research and Development (Drs T. Kato, Kuwahara, and Ozasa). The founder had no role in the study design, collection, analysis or interpretation of the data, writing the manuscript or the decision to submit the paper for publication.
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T.Kato. and T.Kimura. conceived the study and designed the project. Y.M., T.Kato. and T.Morimoto. conducted statistical analysis. Y.M., T.Kato., T.Morimoto., N.O., H.Y., Y.I., Y.T., E.Y., Y.Y., T.Kitai., M.I., K.N., Y.K., T.Morinaga., Y.F., K.A., Y.S., K.K., K.O., and T.Kimura. analyzed or interpreted the data. Y.M., T.Kato., T.Morimoto, and T.Kimura. wrote the main manuscript. All authors reviewed, edited, and approved the final version.
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Miyoshi, Y., Kato, T., Morimoto, T. et al. Prevalence and clinical significance of guideline-directed medical therapy in acute heart failure with reduced or mildly reduced ejection fraction. Sci Rep (2026). https://doi.org/10.1038/s41598-026-35835-5
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DOI: https://doi.org/10.1038/s41598-026-35835-5
