Readmission Rates in Reduced Ejection Fraction Heart Failure Patients on Triple Guideline-Directed Medical Therapy at Hospital Discharge

Background: Heart failure (HF) places a significant burden on the health care system, driven primarily by HF hospitalizations. While HF guidelines recommend initiation of quadruple guideline-directed medical therapy (GDMT) in patients with HF with reduced ejection fraction (HFrEF), in-hospital initiation of quadruple therapy remains a clinical challenge, particularly in patients with additional high-risk comorbidities. Objective: The purpose of this study was to compare the efficacy and safety of triple GDMT with a sodium-glucose cotransporter inhibitor (SGLTi) vs mineralocorticoid receptor antagonist (MRA) added to beta blocker and angiotensin-converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB)/angiotensin receptor-neprilysin inhibitor (ARNi). Methods: This retrospective cohort study was conducted in hospitalized patients with acute HFrEF. Patients who received triple GDMT therapy with a SGLTi or MRA added to beta blocker and ACEi/ARB/ARNi therapy at discharge were compared. The primary outcome was 90-day readmission for HF with secondary outcomes of 30-day readmission for HF and 90-day readmission for GDMT-associated adverse events. Results: A total of 210 patients were included (SGLTi group, n = 105; MRA group, n = 105). Rates of 90-day readmission for HF between SGLTi and MRA groups were 23 (21.90%) vs 15 (14.29%); P = 0.1516. After adjusting for co-variables associated with 90-day readmission, 90-day readmission for HF was not significantly different in patients in the SGLTi vs MRA group (adjusted hazard ratio = 1.742, 95% confidence interval [CI] = 0.833 to 3.434; P = 0.1092). Rates of 90-day readmission for GDMT-associated adverse events were similar between groups. Conclusion and Relevance: In this cohort of patients receiving triple GDMT at discharge after hospitalization for acute HFrEF, triple therapy with an SGLTi vs MRA resulted in similar rates of 90-day HF hospitalization.