Heart failure & cardiomyopathies
Early Prescription of Quadruple Therapy in Acute Decompensated Heart Failure with Reduced Ejection Fraction: A Propensity Score-Matched Analysis
Main finding · 30 day mortality/rehospitalizationResult — go to the resultRelative risk 0.73 95% CI 0.55–0.97Authors' conclusion
In this HFrEF cohort, early initiation of comprehensive GDMT during ADHF hospitalization was associated with improved clinical outcomes. Future randomized trials including patients across the full spectrum of ejection fraction are needed to validate these findings and determine their applicability to other heart failure phenotypes.
Study context
- Population
- Heart failure with reduced ejection fraction (HFrEF) patients (71% male, median age 68 years) hospitalized for acute decompensated heart failure (ADHF) between June 2022 and March 2024HFrEF patients hospitalized for ADHF, 898 (43.8%) received early quadruple therapy
- Participants
- 2,051 patients
- Exposure
- Early in-hospital quadruple guideline-directed medical therapy (GDMT) prescription in ADHF patients with HFrEF
- Early quadruple therapyn = 898
Methodological detailsoptimal full matching propensity score methodology, registry-based (ICARUS)
- Optimal full matching propensity score methodology
- Registry-based (ICARUS)
Main finding
30 day mortality/rehospitalization · 30 day
Relative risk
0.73
95% CI 0.55–0.97
P = 0.028
Early quadruple therapy vs No early quadruple therapy
RR 0.73 (95% CI 0.55–0.97); P = 0.028
As reported in the abstract
Observational data: associations, not effects.
Further findings
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| In-hospital mortality · reduced with early quadruple therapy | 0.29 (0.15–0.56) | P < 0.001 | |
| GDMT continuation at discharge · higher with early quadruple therapy | 3.82 (3.01–4.86) | P < 0.001 | |
| 0.10.31310Relative risk (log scale) |
| Outcome | β (days) (95% CI) | P value |
|---|---|---|
| Hospital stay · shorter with early quadruple therapy | −2.65 (−3.67 to −1.63) | P < 0.001 |
Original publication
Early Prescription of Quadruple Therapy in Acute Decompensated Heart Failure with Reduced Ejection Fraction: A Propensity Score-Matched Analysis. ESC Heart Fail. Published 15 April 2025. doi:10.
Summarised from the published abstract; every number is checked against it