Heart failure & cardiomyopathiesCohort study
Temporal changes in guideline-directed medical therapy score and clinical outcomes in patients with heart failure
- multicentre prospective cohort study
- inverse probability of treatment weighting
Authors' conclusion
In this contemporary chronic HF cohort, the GDMT score incorporating guideline-recommended drugs revealed suboptimal implementation and intensification of GDMT over 9 months. Greater increases in GDMT score were associated with improved clinical outcomes, supporting the clinical relevance of longitudinal GDMT optimization.
Study context
- Population
- Patients with chronic heart failure (HF) with reduced ejection fraction
- Participants
- 680 patients
- Exposure
- uptitration vs no uptitration
- uptitrationn = 282
- no uptitrationn = 398reference
- Outcome
- Composite of:
- All-cause death
- Hospitalization for worsening HF
Main finding
As reported in the abstract
Adjusted hazard ratio
0.65
95% CI 0.43–0.98
uptitration vs no uptitration
adjusted HR 0.65 (95% CI 0.43–0.98)
Observational data: associations, not effects.
Further findings
Uptitration rates · 9 months
- renin-angiotensin system blockers
- 31.8%
- β-blockers
- 28.2%
- mineralocorticoid receptor antagonists
- 10.6%
- sodium-glucose cotransporter 2 inhibitors
- 11.9%
Factors associated with uptitration
- Uptitration was independently associated with baseline guideline-directed medical therapy (GDMT) score, age, left ventricular ejection fraction, blood pressure, and renal function
Original publication
Temporal changes in guideline-directed medical therapy score and clinical outcomes in patients with heart failure. Eur Heart J Qual Care Clin Outcomes. Published 19 June 2026. doi:10.1093/ehjqcco/qcag105
Summarised from the published abstract; every number is checked against it