Heart failure & cardiomyopathiesCohort study
Hospital Heart Failure Medical Therapy Score and Associated Clinical Outcomes and Costs
- Retrospective cohort study
- registry-based
- 360 hospitals
- Data analyzed July 2022 to April 2023
- Costs from the CMS perspective
Authors' conclusion
Results of this cohort study reveal that hospital variability in GDMT score, clinical outcomes, and costs was significant. Higher GDMT score at discharge was associated with lower mortality, lower mortality or hospitalization, more home time, and lower cost.
Study context
- Population
- Patients hospitalized for HF with Reduced Ejection Fraction (HFrEF) in the Get With the Guidelines-Heart Failure Registry, 2015–2019
- Participants
- 41,161 patients · 360 hospitals
- Exposure
- Hospital guideline-directed medical therapy (GDMT) score at discharge vs clinical outcomes and costs
- Outcome
- Hospital variability in GDMT score (weighted index 0–1) at discharge (AMOR); parallel analyses of mortality, HF rehospitalization, mortality or HF rehospitalization, home time and costs; associations with hospital GDMT score (Spearman)
- Follow-up
- 90 days
Main finding
As reported in the abstract
Association of higher hospital GDMT score with outcomes and costs
- Mortality: Spearman ρ −0.22 (95% CI −0.32 to −0.12)
- P < .001
- Mortality or heart failure (HF) rehospitalization: Spearman ρ −0.17 (95% CI −0.26 to −0.06)
- P = .002
- Home time: Spearman ρ 0.14 (95% CI 0.03-0.24)
- P = .01
- Cost: Spearman ρ −0.11 (95% CI −0.21 to 0)
- P = .047
- HF rehospitalization (not associated): Spearman ρ −0.10 (95% CI −0.20 to 0)
- P = .06
Observational data: associations, not effects.
Further findings
Hospital variability (adjusted median odds ratio (AMOR))
- GDMT score at discharge: AMOR
- 1.23 (95% CI 1.21-1.26)
- Mortality: AMOR
- 1.17 (95% CI 1.14-1.24)
- HF rehospitalization: AMOR
- 1.22 (95% CI 1.18-1.27)
- Mortality or HF rehospitalization: AMOR
- 1.21 (95% CI 1.18-1.26)
- Home time: AMOR
- 1.07 (95% CI 1.06-1.10)
- Costs: AMOR
- 1.23 (95% CI 1.21-1.26)
- significant hospital variability
Original publication
Hospital Heart Failure Medical Therapy Score and Associated Clinical Outcomes and Costs. JAMA Cardiol. Published 1 November 2024. doi:10.1001/jamacardio.2024.2969
Summarised from the published abstract; every number is checked against it