Heart failure & cardiomyopathiesCohort study
Get With The Guidelines–Heart Failure Hospital Participation and Its Association With Guideline-Directed Medical Therapy and Outcomes
- retrospective analysis
- multiple baseline time series design
- Medicare beneficiaries with part A and part D
- 2013-2021
Authors' conclusion
Hospital participation in GWTG-HF was associated with modest but significant improvements in postdischarge GDMT intensity, supporting the value of quality improvement initiatives to address persistent treatment gaps in heart failure with reduced ejection fraction.
Study context
- Population
- Medicare beneficiaries with part A and part D hospitalized with heart failure with reduced ejection fractionMedicare beneficiaries hospitalized for heart failure with reduced ejection fraction, 53.5% at never-participating hospitals, 9.6% at Get With The Guidelines-Heart Failure (GWTG-HF) hospitals
- Participants
- 1,274 863 beneficiaries
- Exposure
- changes in guideline-directed medical therapy (GDMT) and outcomes before and after GWTG-HF enrollment with hospitals that never participated
- Outcome
- GDMT score (coprimary, parallel and nonparallel slopes model)
- Follow-up
- 90-day postdischarge
Main finding
As reported in the abstract
Difference in GDMT score (higher with enrollment)
+0.15 points
95% CI 0.12–0.20
P < 0.001
By group
GWTG-HF hospitals
4.5
unadjusted median GDMT score (from 3.0)
nonparticipating hospitals
4.0
unadjusted median GDMT score (from 3.0)
Observational data: associations, not effects.
Secondary outcomes
| Outcome | odds ratio (95% CI) | P value | |
|---|---|---|---|
| All-cause mortality · 30 days and 1 year | 0.95 (0.92–0.98) | P < 0.05 | |
| 0.512Odds ratio (log scale) |
- All-cause mortality: Mortality differences were attenuated and no longer significant in the nonparallel slopes model.
Class-specific medication use
- Greater use of β-blockers, renin-angiotensin system inhibitors, and mineralocorticoid receptor antagonists but not angiotensin receptor-neprilysin inhibitors
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Summarised from the published abstract; every number is checked against it