CJC Open. 2026 Jul 20;8(10):1310-1323. doi: 10.1016/j.cjco.2026.06.022. eCollection 2026 Oct.
ABSTRACT
BACKGROUND: Reported results indicate that implementation rates of guideline-directed medical therapy (GDMT) are associated with improved prognosis and cardiac function in heart failure (HF) patients. This study aimed to investigate the relationship between what we term a "simple GDMT score" calculated at discharge and subsequent cardiac reverse remodelling and long-term outcomes in patients hospitalized for acute decompensated HF, using data from the Japanese Registry of Acute Decompensated Heart Failure (JROADHF-NEXT) prospective registry.
METHODS: We analyzed 2313 hospitalized patients with HFrEF or HFmrEF, stratifying them into high-score (≥ 5 points) and low-score (< 5 points) groups based on their discharge GDMT score.
RESULTS: The high-score group demonstrated a significantly lower risk of the composite endpoint of cardiovascular death or HF rehospitalization (hazard ratio = 0.64, 95% confidence interval: 0.55-0.76), an association that remained significant following multivariable adjustment (adjusted model: hazard ratio = 0.70, 95% confidence interval: 0.56-0.88). Furthermore, the high-score group exhibited significantly greater improvements in echocardiographic indices, including absolute changes in left ventricular ejection fraction (P < 0.001), left ventricular end-diastolic volume index (P < 0.001), and left ventricular end-systolic volume index (P < 0.001), and showed significant reductions in brain natriuretic peptide (P = 0.005) and N-terminal pro brain natriuretic peptide levels (P < 0.001) at 1-year follow-up assessment.
CONCLUSIONS: A higher simple GDMT score at discharge is independently associated with better 2-year clinical outcomes and favourable cardiac reverse remodelling in this cohort of HFrEF/HFmrEF patients hospitalized for acute decompensated HF. These findings suggest that a simple assessment of GDMT at discharge may serve as a practical benchmark of discharge medical optimization in routine clinical care.
PMID:42861231 | PMC:PMC13654385 | DOI:10.1016/j.cjco.2026.06.022