Agrawal Simran, Alhaddad Zayd, Nabia Sarah, Rehman Obaid Ur, Kiyani Madiha, Kumar Ajay, Regmi Nripesh, Pingili Adhvithi, Garg Tushar, Allamaneni Rakesh, Paudel Amrit, Fonarow Greg C, Agarwal Anup
Department of Medicine, MedStar Health, Baltimore, Maryland.
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
J Card Fail. 2025 Apr;31(4):635-645. doi: 10.1016/j.cardfail.2024.08.059. Epub 2024 Sep 25.
The American Heart Association/American College of Cardiology/Heart Failure Society of America recently added sodium-glucose cotransporter-2 inhibitors in addition to renin-angiotensin-aldosterone system inhibitors, beta-blockers, and mineralocorticoid receptor antagonists to form the 4 pillars of guideline-directed medical therapy (GDMT) for the management of heart failure with reduced ejection fraction (HFrEF). Despite strong evidence suggesting improved outcomes with inpatient initiation of GDMT at target doses, significant lag has been noted in prescription practices. We sought to study GDMT prescription rates in patients with HFrEF at the time of hospital discharge and evaluate its association with various patient characteristics and all-cause readmission rates.
We used a modified version of Heart Failure Collaboratory (HFC) score to characterize patients into 2 groups (those with an HFC score of <3 and an HFC score of ≥3) and to examine various socioeconomic and biomedical factors affecting GDMT prescription practices. Out of the eligible patients, the prescription rates for beta-blockers was 77.9%, renin-angiotensin-aldosterone system inhibitor was 70.3%, and mineralocorticoid receptor antagonists was 41%. Furthermore, prescription rates for sacubitril/valsartan was 27.7% and sodium-glucose cotransporter-2 inhibitors was 17%. Only 1% of patients had an HFC score of 9 (drugs from all 4 classes at target doses). Patients of black ethnicity, those admitted on teaching service and those with HFrEF as the primary cause of admission were more likely to have an HFC of ≥3 at discharge. An HFC of ≥3 was associated with lower rates of 1-month all-cause readmissions.
Consistent with the prior research, our data show significant gaps in prescription of GDMT in HFrEF. Further implementation research should be done to improve GDMT prescription during inpatient stay.
美国心脏协会/美国心脏病学会/美国心力衰竭学会最近将钠-葡萄糖协同转运蛋白2抑制剂添加到肾素-血管紧张素-醛固酮系统抑制剂、β受体阻滞剂和盐皮质激素受体拮抗剂中，形成了射血分数降低的心力衰竭（HFrEF）管理的指南指导药物治疗（GDMT）的四大支柱。尽管有强有力的证据表明，以目标剂量在住院期间启动GDMT可改善预后，但在处方实践中仍存在显著滞后。我们试图研究出院时HFrEF患者的GDMT处方率，并评估其与各种患者特征及全因再入院率的关联。
我们使用心力衰竭协作组（HFC）评分的改良版将患者分为两组（HFC评分<3和HFC评分≥3），并研究影响GDMT处方实践的各种社会经济和生物医学因素。在符合条件的患者中，β受体阻滞剂的处方率为77.9%，肾素-血管紧张素-醛固酮系统抑制剂为70.3%，盐皮质激素受体拮抗剂为41%。此外，沙库巴曲/缬沙坦的处方率为27.7%，钠-葡萄糖协同转运蛋白2抑制剂为17%。只有1%的患者HFC评分为9（所有4类药物均为目标剂量）。黑人患者、在教学服务科室入院的患者以及以HFrEF作为主要入院原因的患者出院时更有可能HFC≥3。HFC≥3与1个月全因再入院率较低相关。
与先前的研究一致，我们的数据显示HFrEF患者在GDMT处方方面存在显著差距。应开展进一步的实施研究以改善住院期间的GDMT处方。
