Early prescription of quadruple therapy in acute decompensated heart failure with reduced ejection fraction: A propensity score‐matched analysis
Abstract Aims The optimal timing for prescribing guideline‐directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF) during acute decompensated heart failure (ADHF) remains uncertain. This study evaluated the real‐world impact of early in‐hospital quadrupl...
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Wiley
2025-08-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.15286 |
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| author | Luis E. Echeverría Lyda Z. Rojas Angie Yarlady Serrano‐García Daniel Botero Karen Andrea García‐Rueda Ángela Torres‐Bustamante Diana Ivonne Cañón‐Gómez Juan Sebastián Salcedo Alexandra Hurtado‐Ortiz Jaime A. Rodríguez Sergio A. Gómez‐Ochoa |
| author_facet | Luis E. Echeverría Lyda Z. Rojas Angie Yarlady Serrano‐García Daniel Botero Karen Andrea García‐Rueda Ángela Torres‐Bustamante Diana Ivonne Cañón‐Gómez Juan Sebastián Salcedo Alexandra Hurtado‐Ortiz Jaime A. Rodríguez Sergio A. Gómez‐Ochoa |
| author_sort | Luis E. Echeverría |
| collection | DOAJ |
| description | Abstract Aims The optimal timing for prescribing guideline‐directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF) during acute decompensated heart failure (ADHF) remains uncertain. This study evaluated the real‐world impact of early in‐hospital quadruple GDMT prescription in ADHF patients with HFrEF. Methods and Results In this retrospective cohort study using the Institutional aCute descompensAted heaRt failUre regiStry (ICARUS), we analysed 2051 HFrEF patients (71% male, median age 68 years) hospitalized for ADHF between June 2022 and March 2024. Early quadruple therapy was defined as the prescription of beta‐blockers, angiotensin‐converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs)/angiotensin receptor–neprilysin inhibitors (ARNIs), mineralocorticoid receptor antagonists (MRAs) and sodium–glucose cotransporter‐2 inhibitors (SGLT2is) within 48 h of admission. Among included patients, 898 (43.8%) received early quadruple therapy. Using optimal full matching propensity score methodology, early quadruple therapy was associated with lower 30 day mortality/rehospitalization [relative risk (RR) 0.73; 95% confidence interval (CI) 0.55–0.97, P = 0.028], reduced in‐hospital mortality (RR 0.29; 95% CI 0.15–0.56, P < 0.001) and shorter hospital stay (β = −2.65 days; 95% CI −3.67 to −1.63, P < 0.001). Patients receiving early quadruple therapy showed higher rates of GDMT continuation at discharge (RR 3.82; 95% CI 3.01–4.86, P < 0.001). Conclusions In this HFrEF cohort, early initiation of comprehensive GDMT during ADHF hospitalization was associated with improved clinical outcomes. Future randomized trials including patients across the full spectrum of ejection fraction are needed to validate these findings and determine their applicability to other heart failure phenotypes. |
| format | Article |
| id | doaj-art-7b86d4f1b7af49dbb5e89cb455da2be2 |
| institution | Matheson Library |
| issn | 2055-5822 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Wiley |
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| series | ESC Heart Failure |
| spelling | doaj-art-7b86d4f1b7af49dbb5e89cb455da2be22025-07-24T10:14:12ZengWileyESC Heart Failure2055-58222025-08-011242814282610.1002/ehf2.15286Early prescription of quadruple therapy in acute decompensated heart failure with reduced ejection fraction: A propensity score‐matched analysisLuis E. Echeverría0Lyda Z. Rojas1Angie Yarlady Serrano‐García2Daniel Botero3Karen Andrea García‐Rueda4Ángela Torres‐Bustamante5Diana Ivonne Cañón‐Gómez6Juan Sebastián Salcedo7Alexandra Hurtado‐Ortiz8Jaime A. Rodríguez9Sergio A. Gómez‐Ochoa10Heart Failure and Transplant Clinic Fundación Cardiovascular de Colombia Floridablanca ColombiaResearch Center Fundación Cardiovascular de Colombia Floridablanca ColombiaHeart Failure and Transplant Clinic Fundación Cardiovascular de Colombia Floridablanca ColombiaHeart Failure and Transplant Clinic Fundación Cardiovascular de Colombia Floridablanca ColombiaHeart Failure and Transplant Clinic Fundación Cardiovascular de Colombia Floridablanca ColombiaHeart Failure and Transplant Clinic Fundación Cardiovascular de Colombia Floridablanca ColombiaDepartment of Cardiology Fundación Cardiovascular de Colombia Floridablanca ColombiaDepartment of Cardiology Fundación Cardiovascular de Colombia Floridablanca ColombiaEpidemiology Unit Fundación Cardiovascular de Colombia Floridablanca ColombiaHeart Failure and Transplant Clinic Fundación Cardiovascular de Colombia Floridablanca ColombiaHeart Failure and Transplant Clinic Fundación Cardiovascular de Colombia Floridablanca ColombiaAbstract Aims The optimal timing for prescribing guideline‐directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF) during acute decompensated heart failure (ADHF) remains uncertain. This study evaluated the real‐world impact of early in‐hospital quadruple GDMT prescription in ADHF patients with HFrEF. Methods and Results In this retrospective cohort study using the Institutional aCute descompensAted heaRt failUre regiStry (ICARUS), we analysed 2051 HFrEF patients (71% male, median age 68 years) hospitalized for ADHF between June 2022 and March 2024. Early quadruple therapy was defined as the prescription of beta‐blockers, angiotensin‐converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs)/angiotensin receptor–neprilysin inhibitors (ARNIs), mineralocorticoid receptor antagonists (MRAs) and sodium–glucose cotransporter‐2 inhibitors (SGLT2is) within 48 h of admission. Among included patients, 898 (43.8%) received early quadruple therapy. Using optimal full matching propensity score methodology, early quadruple therapy was associated with lower 30 day mortality/rehospitalization [relative risk (RR) 0.73; 95% confidence interval (CI) 0.55–0.97, P = 0.028], reduced in‐hospital mortality (RR 0.29; 95% CI 0.15–0.56, P < 0.001) and shorter hospital stay (β = −2.65 days; 95% CI −3.67 to −1.63, P < 0.001). Patients receiving early quadruple therapy showed higher rates of GDMT continuation at discharge (RR 3.82; 95% CI 3.01–4.86, P < 0.001). Conclusions In this HFrEF cohort, early initiation of comprehensive GDMT during ADHF hospitalization was associated with improved clinical outcomes. Future randomized trials including patients across the full spectrum of ejection fraction are needed to validate these findings and determine their applicability to other heart failure phenotypes.https://doi.org/10.1002/ehf2.15286acute decompensated heart failureGDMTheart failuremortalityoutcomes |
| spellingShingle | Luis E. Echeverría Lyda Z. Rojas Angie Yarlady Serrano‐García Daniel Botero Karen Andrea García‐Rueda Ángela Torres‐Bustamante Diana Ivonne Cañón‐Gómez Juan Sebastián Salcedo Alexandra Hurtado‐Ortiz Jaime A. Rodríguez Sergio A. Gómez‐Ochoa Early prescription of quadruple therapy in acute decompensated heart failure with reduced ejection fraction: A propensity score‐matched analysis ESC Heart Failure acute decompensated heart failure GDMT heart failure mortality outcomes |
| title | Early prescription of quadruple therapy in acute decompensated heart failure with reduced ejection fraction: A propensity score‐matched analysis |
| title_full | Early prescription of quadruple therapy in acute decompensated heart failure with reduced ejection fraction: A propensity score‐matched analysis |
| title_fullStr | Early prescription of quadruple therapy in acute decompensated heart failure with reduced ejection fraction: A propensity score‐matched analysis |
| title_full_unstemmed | Early prescription of quadruple therapy in acute decompensated heart failure with reduced ejection fraction: A propensity score‐matched analysis |
| title_short | Early prescription of quadruple therapy in acute decompensated heart failure with reduced ejection fraction: A propensity score‐matched analysis |
| title_sort | early prescription of quadruple therapy in acute decompensated heart failure with reduced ejection fraction a propensity score matched analysis |
| topic | acute decompensated heart failure GDMT heart failure mortality outcomes |
| url | https://doi.org/10.1002/ehf2.15286 |
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