Circulation journal : official journal of the Japanese Circulation Society · 2026
In-Hospital Guideline-Directed Medical Therapy Intensification and Long-Term Outcomes in Patients Hospitalized for Heart Failure in the Current Clinical Paradigm - Insights From the QHEART-R Study.
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Hashimoto Toru, Matsukawa Ryuichi, Matsushima Shouji, Misumi Kayo, Fujino Takeo, Shinohara Keisuke, Fujiwara Masaki, Umemoto Shintaro, Furusawa Shun, Ishikita Akihito, Ishimaru Kosei, Kisanuki Hiroshi, Tokumoto Masahiro, Yoshitake Tomoaki, Ikuta Kei, Taniguchi Gentaro, Abe Kohtaro, QHEART-R Study Group
Аннотация
BACKGROUND: The real-world impact of in-hospital intensification of guideline-directed medical therapy (GDMT) on clinical outcomes in patients with heart failure (HF) remains uncertain. We evaluated the association between in-hospital GDMT intensification and long-term outcomes using data from the multicenter QHEART-R cohort.
METHODS AND RESULTS: We analyzed 3,190 patients hospitalized for worsening HF. In-hospital GDMT intensification was quantified by the change in the simple GDMT score from admission to discharge (∆S-GDMT). The primary outcome was a composite of all-cause death or hospitalization for HF (HHF). The mean (±SD) age of the cohort was 77.7±14.0 years, 53% were male, and the mean hospital stay was 20±16 days. The cohort included 1,477 (46%) patients with HF with reduced ejection fraction (HFrEF), 435 (14%) with HF with mildly reduced ejection fraction (HFmrEF), and 1,276 (40%) with HF with preserved ejection fraction. Four-year event-free survival was 32.4% for the primary outcome, 82.5% for cardiovascular (CV) death, and 50.4% for HHF. In patients with HFrEF/HFmrEF, a greater ∆S-GDMT was independently associated with a lower risk of the primary outcome (adjusted hazard ratio 0.90; 95% confidence interval 0.86-0.93; P<0.001), regardless of the number of prior HHF or the simple GDMT score at discharge.
CONCLUSIONS: In-hospital GDMT intensification was associated with improved long-term outcomes in patients with HFrEF/HFmrEF. Hospitalization represents a critical opportunity to optimize GDMT and improve prognosis.
METHODS AND RESULTS: We analyzed 3,190 patients hospitalized for worsening HF. In-hospital GDMT intensification was quantified by the change in the simple GDMT score from admission to discharge (∆S-GDMT). The primary outcome was a composite of all-cause death or hospitalization for HF (HHF). The mean (±SD) age of the cohort was 77.7±14.0 years, 53% were male, and the mean hospital stay was 20±16 days. The cohort included 1,477 (46%) patients with HF with reduced ejection fraction (HFrEF), 435 (14%) with HF with mildly reduced ejection fraction (HFmrEF), and 1,276 (40%) with HF with preserved ejection fraction. Four-year event-free survival was 32.4% for the primary outcome, 82.5% for cardiovascular (CV) death, and 50.4% for HHF. In patients with HFrEF/HFmrEF, a greater ∆S-GDMT was independently associated with a lower risk of the primary outcome (adjusted hazard ratio 0.90; 95% confidence interval 0.86-0.93; P<0.001), regardless of the number of prior HHF or the simple GDMT score at discharge.
CONCLUSIONS: In-hospital GDMT intensification was associated with improved long-term outcomes in patients with HFrEF/HFmrEF. Hospitalization represents a critical opportunity to optimize GDMT and improve prognosis.