EVOLUTION HF: Earlier and Greater Implementation of GDMT Needed After HF Hospitalization

After hospitalization for heart failure (hHF), the risk of rehospitalization as well as costs was high, while the use of guideline-directed medical therapy (GDMT) during the first year after discharge did not increase, according to a study published June 21 in JACC: Heart Failure. The findings suggest the need to focus on earlier and greater use of GDMT to reduce these risks. 

Biykem Bozkurt, MD, PhD, FACC, et al., conducted a multinational, observational, longitudinal cohort study to obtain contemporary data on outcomes, costs and treatment after hHF in representative populations. Using data from electronic health records or claims data sources for 263,525 patients in Japan, Sweden, the UK and the U.S., between 2018 and 2022, they assessed rehospitalization, hospitalization cost, mortality after hHF and use of GDMT.

Results showed that within the first year after discharge, 28% of patients died. HF was the main driver of rehospitalization, with a one-year event rate per 100 patient-years (ER) of 13.6 (95% CI, 9.8-17.4), followed by chronic kidney disease (ER, 4.5 [95% CI, 3.6-5.3]). They were also the main drivers of higher health care costs.

Researchers also found there was little change in the use of renin-angiotensin system inhibitors, sacubitril/valsartan, beta-blockers and mineralocorticoid receptor antagonists between 2020 and 2022. However, an increase of two- to seven-fold in the use of SGLT2 inhibitors was observed.

The authors note this is the largest and most contemporary study of patients following an incident of hHF. Furthermore, they write that “relatively few patients were treated with all [four] foundational therapies despite many of them being likely to have indications for them…” They conclude that “Optimized GDMT use may reduce risks and costs during the vulnerable post-hHF period and improve patient outcomes.” Implementation strategies to address the barriers to optimal GDMT are needed.

Clinical Topics: Dyslipidemia, Lipid Metabolism, Novel Agents

Keywords: Electronics, Angiotensins, Renal Insufficiency, Chronic, Valsartan, Sodium-Glucose Transporter 2 Inhibitors, Patient Discharge, Sodium-Glucose Transporter 2, Renin, Patient Readmission, Mineralocorticoid Receptor Antagonists

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