Prognostic Utility of Three Guideline-Directed Medical Therapy (GDMT) Scoring Systems in Patients with Heart Failure with Reduced Ejection Fraction: Single center Cohort study

초록

Background: Guideline-directed medical therapy (GDMT) is the fundamental treatment for heart failure with reduced ejection fraction (HFrEF). To facilitate the implementation of GDMT and quantify treatment quality, three scoring systems?the Heart Failure Collaboratory (HFA) score, a modified HFA score, and a proposed four-pillar intensification (P4P) score?have been developed. This study aimed to evaluate the predictive performance and clinical utility of these scoring systems in a real-world cohort. Methods: We conducted a single-center, retrospective cohort study including 690 hospitalized patients with HFrEF between January 2020 and June 2024. GDMT prescription status was assessed at discharge. Each patient's HFA, modified HFA, and proposed P4P scores were calculated. The association between each score and a composite outcome of all-cause mortality or heart failure rehospitalization was analyzed using multivariable Cox regression, adjusted for demographic and clinical covariates. Kaplan-Meier survival analysis and restricted mean survival time (RMST) comparisons were also performed. Results: The mean age was 70 ± 15 years, 67% males, and the mean left ventricular ejection fraction was 30.9 ± 6.7%. The mean scores were 3.0 ± 1.3 for the HFA score, 4.9 ± 2.5 for the modified HFA score, and 5.9 ± 2.9 for the proposed P4P score. All three scoring systems were significantly associated with the composite outcome in adjusted Cox regression models: HFA score (HR 0.77, 95% CI 0.66?0.91, p=0.001), modified HFA score (HR 0.86, 95% CI 0.79?0.93, p<0.001), and proposed P4P score (HR 0.89, 95% CI 0.83?0.96, p=0.003). The RMST analysis showed a 37.0-day improvement in 1-year event-free survival among patients with high HFA scores compared to those with low scores (95% CI 4.5?69.5, p=0.026). The concordance indices for the models were 0.671 for the HFA score, 0.669 for the modified HFA score, and 0.664 for the proposed P4P score.