Clinical characteristics associated with failure to achieve a prespecified guideline-directed medical therapy target at discharge in patients with HFrEF undergoing scheduled hospitalization: a secondary analysis of the HEROES study

Abstract

Abstract Guideline-directed medical therapy (GDMT) is crucial for the pharmacological management of heart failure (HF) with reduced ejection fraction (HFrEF). The aim of the study was to identify clinical characteristics associated with failure to achieve the prespecified stringent GDMT target in patients with HFrEF undergoing scheduled hospitalization. The analysis included 287 patients with reduced left ventricular ejection fraction (LVEF), which is a subset of the 1422 participants of the HEROES study, a prospective, multicenter, observational study of HF patients. For this analysis, high-dose GDMT (hd_GDMT, prespecified GDMT target) was defined as the administration of all four GDMT classes at doses ≥ 50%. The analyzed cohort was predominantly male ( n = 232; 80.8%), with an average age of 63.6 ± 13.7 years and a mean LVEF of 26.9 ± 8.2%. Only 64 patients (22.3%) achieved the hd_GDMT. Clinical characteristics associated with failure to achieve the prespecified stringent GDMT target included sex, age, body mass index, anaemia, renal function, and de novo HF diagnosis. In multivariate logistic regression analysis, female sex (odds ratio [OR] = 4.02), de novo HF (OR = 11.001), and anemia at discharge (OR = 4.12) were independently associated with failure to achieve hd_GDMT. These findings describe associations with treatment intensity at discharge and should not be interpreted as evidence of causal barriers or inappropriate treatment decisions.