A low guideline-directed medical therapy score is associated with adverse outcomes in patients with heart failure with a reduced ejection fraction and renal dysfunction.

Objective To examine the association between the guideline-directed medical therapy (GDMT) intensity at discharge and the long-term prognosis in patients with heart failure (HF) with a reduced ejection fraction (HFrEF) and renal dysfunction. Methods We retrospectively analyzed the data of 626 patients between September 2015 and July 2023. The GDMT score, based on the dose and type, was classified by the median into low-GDMT (≤4) and high-GDMT (≥5) groups. The primary outcomes were all-cause mortality or HF rehospitalization. Patients The patients admitted with HFrEF, left ventricular ejection fraction <40%, and an estimated glomerular filtration rate <60 mL/min/1.73 m2 at discharge were included. Results The median GDMT score was 4, and 265 patients (42%) developed the primary outcome during a median follow-up of 24 months. The low-GDMT group had an older age, a reduced renal function, and higher B-type natriuretic peptide (BNP) levels. The incidence of the primary outcome was significantly higher in the low-GDMT group (log-rank p=0.001). In a multivariate analysis, a low GDMT score independently predicted the primary outcomes (hazard ratio: 1.432; 95% confidence interval: 1.087-1.886, p=0.011). The factors associated with low GDMT scores included an older age, higher BNP levels, an absence of diabetes, an absence of implantable cardioverter-defibrillator or cardiac resynchronization therapy, and an absence of oral anticoagulants. Conclusion A higher GDMT score at discharge was significantly associated with an improved prognosis in patients with HFrEF and renal dysfunction. The GDMT score may be a useful tool for assessing treatment appropriateness in this high-risk population.