Utility of Guideline-Directed Therapy on Mortality and Readmissions in Socioeconomically Disadvantaged Heart Failure Patients.

Abstract

Heart failure with reduced ejection fraction (HFrEF) represents a significant public health challenge, affecting millions worldwide with high morbidity and mortality rates. Admissions due to HFrEF impose a considerable financial burden on patients and healthcare systems. Guideline-directed medical therapy (GDMT) has emerged as a proven strategy to reduce morbidity and mortality in heart failure (HF) patients. Our aim was to evaluate the utility of in-hospital initiation of 4-pillar GDMT in preventing 30-day readmission and mortality among high-risk socioeconomic populations with HFrEF in Brooklyn, New York. A retrospective analysis of consecutive HFrEF patients admitted for HF exacerbation between November 2021 and May 2023 Primary outcomes were all-cause mortality, 30-day readmission rates, and duration of hospitalization stratified by the number of GDMT pillars implemented (<2, 2, 3, or 4). In total 603 HFrEF readmissions from 502 patients were identified. Of those, 59% were African American and 38% were female. Mortality significantly decreased with increasing GDMT pillars at discharge (P = 0.03). While the 30-day readmission rate did not reach statistical significance (P = 0.28), a linear trend emerged, with reductions up to 3 GDMT pillars and a slight increase (14-16%) with 4 pillars. Our findings suggest universal applicability of GDMT benefits across diverse ethnicities. Optimal outcomes, including lower 30-day readmission rates and cost savings, were achieved with 3 GDMT pillars upon discharge in this high-risk population, highlighting the possibility of optimization for future interventions. Further research is necessary to elucidate the optimal number and intensity of GDMT postdischarge initiation in at-risk populations.