Readmission Rates in Reduced Ejection Fraction Heart Failure Patients on Triple Guideline-Directed Medical Therapy at Hospital Discharge.

BACKGROUND

Heart failure (HF) places a significant burden on the health care system, driven primarily by HF hospitalizations. While HF guidelines recommend initiation of quadruple guideline-directed medical therapy (GDMT) in patients with HF with reduced ejection fraction (HFrEF), in-hospital initiation of quadruple therapy remains a clinical challenge, particularly in patients with additional high-risk comorbidities.

OBJECTIVE

The purpose of this study was to compare the efficacy and safety of triple GDMT with a sodium-glucose cotransporter inhibitor (SGLTi) vs mineralocorticoid receptor antagonist (MRA) added to beta blocker and angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB)/angiotensin receptor-neprilysin inhibitor (ARNi).

METHODS

This retrospective cohort study was conducted in hospitalized patients with acute HFrEF. Patients who received triple GDMT therapy with a SGLTi or MRA added to beta blocker and ACEi/ARB/ARNi therapy at discharge were compared. The primary outcome was 90-day readmission for HF with secondary outcomes of 30-day readmission for HF and 90-day readmission for GDMT-associated adverse events.

RESULTS

A total of 210 patients were included (SGLTi group, n = 105; MRA group, n = 105). Rates of 90-day readmission for HF between SGLTi and MRA groups were 23 (21.90%) vs 15 (14.29%); = 0.1516. After adjusting for co-variables associated with 90-day readmission, 90-day readmission for HF was not significantly different in patients in the SGLTi vs MRA group (adjusted hazard ratio = 1.742, 95% confidence interval [CI] = 0.833 to 3.434; = 0.1092). Rates of 90-day readmission for GDMT-associated adverse events were similar between groups.

CONCLUSION AND RELEVANCE

In this cohort of patients receiving triple GDMT at discharge after hospitalization for acute HFrEF, triple therapy with an SGLTi vs MRA resulted in similar rates of 90-day HF hospitalization.