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Additive Benefit of Guideline-Directed Medical Therapies at Discharge in Reducing 30-Day Readmissions in Heart Failure

Year: 2025

Type: article

Abstract: BACKGROUND: Hospitalization-related costs for heart failure (HF) are a major contributor to the overall health care expenditure in the United States. Despite recommendations, guideline-directed medical therapy (GDMT) is underutilized at discharge in eligible patients, likely contributing to high readmission rates. Describing the effect of GDMT use at discharge may better inform institutions on the value of implementing focused therapy initiatives. OBJECTIVES: This study aimed to examine the association between the number of active GDMT prescriptions at discharge and 30-day readmissions. METHODS: This retrospective cohort study analyzed 2,121 index hospitalizations for HF across 5 institutions from February 1, 2021, to October 31, 2024. Patients included were adults with a baseline left ventricular ejection fraction ≤40%. The primary outcome was 30-day all-cause readmission, and the secondary outcome was 30-day HF readmission. Multivariable mixed-effects Cox proportional hazard models were used to assess the association between GDMT count and readmission rates. RESULTS: Increased GDMT count at discharge was associated with significantly lower hazard of 30-day all-cause readmission: 1 vs 2 GDMT (HR: 0.79; 95% CI: 0.64-0.97), 1 vs 3 GDMT (HR: 0.70; 95% CI: 0.55-0.90), and 1 vs 4 GDMT (HR: 0.56; 95% CI: 0.40-0.77). Trends were similar for HF-specific readmissions. CONCLUSIONS: Increasing number of GDMT classes prescribed at discharge was associated with a gradient reduction in 30-day all-cause and HF readmissions, with a stronger effect seen with higher GDMT counts. Implementing comprehensive GDMT strategies at discharge may reduce health care costs and enhance institutional performance under national quality metrics.

Source: JACC Advances

DOI: 10.1016/j.jacadv.2025.102411

Authors: Andrew Willeford, Barry Greenberg, Zaid Yousif

Institutions: University of California San Diego, UC San Diego Health System

Language: English

Topic: Heart Failure Treatment and Management

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,936