Prevalence and clinical significance of guideline-directed medical therapy in acute heart failure with reduced or mildly reduced ejection fraction

There are limited reports on the prevalence and clinical significance of guideline-directed medical therapy (GDMT) initiation in patients with acute heart failure (HF). We analyzed 2086 patients with acute heart failure with reduced or mildly reduced ejection fraction (HFrEF or HFmrEF) in the KCHF registry. The patients were classified according to the number of GDMT classes at discharge. The primary outcome was a composite of all-cause death or HF hospitalization. There were 181 (8.7%), 508 (24.4%), 791 (37.9%), and 606 (29.1%) patients with GDMT = 0, 1, 2, and 3, respectively. Current smoker, ambulatory status, and HFrEF were associated with full GDMT, whereas age ≥ 80 years old, acute coronary syndrome, anemia, and eGFR < 30 mL/min/1.73m2 were associated with absence of full GDMT. The cumulative 1-year incidence of the primary outcome was 56.3%, 40.7%, 31.9%, and 25.1% with GDMT = 0, 1, 2, and 3, respectively. The excess adjusted risk of patients with GDMT = 0 or 1, but not GDMT = 2 relative to those of GDMT = 3 remained significant for the primary outcome (HR 2.16 [1.66–2.82], 1.33 [1.07–1.66], and 1.03 [0.84–1.27]). Collectively, the greater number of GDMT classes at discharge was associated with a lower risk for all-cause death or HF hospitalization in patients with HFrEF or HFmrEF. (200 words)