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. 2024 Nov 1;9(11):1029-1038.
doi: 10.1001/jamacardio.2024.2969.

Hospital Heart Failure Medical Therapy Score and Associated Clinical Outcomes and Costs

Vincenzo B Polsinelli  1 , Jie-Lena Sun  2 , Stephen J Greene  2 , Karen Chiswell  2 , Gary K Grunwald  3 , Larry A Allen  1 , Pamela Peterson  1 , Ambarish Pandey  4 , Gregg C Fonarow  5 , Paul Heidenreich  6 , P Michael Ho  1   7 , Paul L Hess  1   7
Affiliations

Hospital Heart Failure Medical Therapy Score and Associated Clinical Outcomes and Costs

Vincenzo B Polsinelli et al. JAMA Cardiol. .

Abstract

Importance: A composite score for guideline-directed medical therapy (GDMT) for patients with heart failure (HF) is associated with increased survival. Whether hospital performance according to a GDMT score is associated with a broader array of clinical outcomes at lower costs is unknown.

Objectives: To evaluate hospital variability in GDMT score at discharge, 90-day risk-standardized clinical outcomes and costs, and associations between hospital GDMT score and clinical outcomes and costs.

Design, setting, and participants: This was a retrospective cohort study conducted from January 2015 to September 2019. Included for analysis were patients hospitalized for HF with reduced ejection fraction (HFrEF) in the Get With the Guidelines-Heart Failure Registry, a national hospital-based quality improvement registry. Study data were analyzed from July 2022 to April 2023.

Exposures: GDMT score at discharge.

Main outcomes and measures: Hospital variability in GDMT score, a weighted index from 0 to 1 of GDMT prescribed divided by the number of medications eligible, at discharge was evaluated using a generalized linear mixed model using the hospital as a random effect and quantified with the adjusted median odds ratio (AMOR). Parallel analyses centering on 90-day mortality, HF rehospitalization, mortality or HF rehospitalization, home time, and costs were performed. Costs were assessed from the perspective of the Centers of Medicare & Medicaid Services. Associations between hospital GDMT score and clinical outcomes and costs were evaluated using Spearman coefficients.

Results: Among 41 161 patients (median [IQR] age, 78 [71-85] years; 25 546 male [62.1%]) across 360 hospitals, there was significant hospital variability in GDMT score at discharge (AMOR, 1.23; 95% CI, 1.21-1.26), clinical outcomes (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) and costs (AMOR, 1.23; 95% CI, 1.21-1.26). Higher hospital GDMT score was associated with lower hospital mortality (Spearman ρ, -0.22; 95% CI, -0.32 to -0.12; P < .001), lower mortality or HF rehospitalization (Spearman ρ, -0.17; 95% CI, -0.26 to -0.06; P = .002), more home time (Spearman ρ, 0.14; 95% CI, 0.03-0.24; P = .01), and lower cost (Spearman ρ, -0.11; 95% CI, -0.21 to 0; P = .047) but not with HF rehospitalization (Spearman ρ, -0.10; 95% CI, -0.20 to 0; P = .06).

Conclusions and relevance: 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. Efforts to increase health care value should include GDMT optimization.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Greene reported receiving grants from the American Heart Association, Amgen, AstraZeneca, Boehringer Ingelheim, Bristol Myers Squibb, Cytokinetics, Merck, Novartis, Pfizer, and Sanofi and personal fees from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Corcept Therapeutics, Corteria Pharmaceuticals, CSL Vifor, Cytokinetics, Eli Lilly, Lexicon, Merck, Novo Nordisk, Otsuka, Roche Diagnostics, Sanofi, scPharmaceuticals, Tricog Health, and Urovant Pharmaceuticals outside the submitted work. Dr Chiswell reported receiving grants from the American Heart Association during the conduct of the study. Dr Allen reported receiving grants from the National Institutes of Health and Patient-Centered Outcomes Research Institute and personal fees from ACI Clinical, Quidel, Novartis, and Boston Scientific during the conduct of the study. Dr Peterson reported receiving personal fees as deputy editor for the Journal of the American Heart Association and grants from the National Heart, Lung, and Blood Institute outside the submitted work. Dr Pandey reported receiving research support from the National Institutes of Health; grant funding from Applied Therapeutics and Gilead Sciences; honoraria outside of the present study as an advisor/consultant for Tricog Health Inc, Lilly USA, Rivus, Cytokinetics, Roche Diagnostics, Axon Therapies, Medtronic, Edward Lifesciences, Science37, Novo Nordisk, Bayer, Merck, Sarfez Pharmaceuticals, Emmi Solutions; nonfinancial support from Pfizer and Merck; and serving as a consultant for Palomarin Inc with stocks compensation. Dr Fonarow reported receiving personal fees from Abbott, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Cytokinetics, Eli Lilly, Johnson & Johnson, Medtronic, Merck, Novartis, and Pfizer outside the submitted work; and serving as associate section editor of JAMA Cardiology. Dr Hess reported receiving grants from Veterans Affairs Health Systems Research VA Career Development Award HX002621 and the Merit Award HX003570 and grants from the American Heart Association Career Development Award 19CDA347670126 during the conduct of the study. No other disclosures were reported.

Figures

Figure.
Figure.. Variability in Guideline-Directed Medical Therapy (GDMT) Scores, 90-Day Mortality, and 90-Day Heart Failure (HF) Rehospitalization Across Hospitals
See this image and copyright information in PMC

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