Heart failure & cardiomyopathies
Efficacy, Safety and Mechanistic Impact of a Heart Failure Guideline-Directed Medical Therapy Clinic
Authors' conclusion
Rapid GDMT implementation via an outpatient GDMT clinic was effective, safe, and associated with improvement in key clinical parameters.
Study context
- Population
- Patients with heart failure (HF) and abnormal EF (<50%) referred to a guideline-directed medical therapy (GDMT) clinic within a general cardiology practice100 without contraindications
- Participants
- 114 patients
- Exposure
- GDMT clinic vs usual care
- GDMT clinicn = 114
- Outcome
- Rates of GDMT prescription (4-drug GDMT use)
- Follow-up
- Baseline to clinic completion (median 15.8 weeks [Q1-Q3: 10.7-23.0 weeks])
Methodological detailssingle general cardiology practice
- Single general cardiology practice
Main finding
As reported in the abstract
4-drug GDMT use (patients without contraindications) · baseline to clinic completion
- 4-drug GDMT use increased from 21% to 88%
- P < 0.001
- Of 4-drug GDMT recipients, ARNI received
- 92%
Observational data: associations, not effects.
Further findings
Achievement of ≥50% target dose
ARNI
Beta-blocker
MRA
SGLT2 inhibitor
Achievement of ≥50% target dose
- Target doses of all 4 drugs reached in nearly 1 in 4 participants
NYHA class II/III · baseline to clinic completion
- Decreased from 94% to 75%
- P < 0.001
NT-proBNP · baseline to clinic completion
- Median decreased from 587 to 534 ng/L, despite loop diuretic reduction
- P = 0.03
LVEF · baseline to clinic completion
- Absolute 6% increase, from 37% [Q1-Q3: 31%-41%] to 43% [Q1-Q3: 38%-53%]
- P < 0.001
Moderate or severe mitral regurgitation
- Substantial decrease
Safety
Tolerability of GDMT titration
- GDMT titration was well-tolerated
Original publication
Efficacy, Safety and Mechanistic Impact of a Heart Failure Guideline-Directed Medical Therapy Clinic. JACC Heart Fail. Published 9 October 2024. doi:10.
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