{
  "abstract": "BACKGROUND: The real-world impact of in-hospital intensification of guideline-directed medical therapy (GDMT) on clinical outcomes in patients with heart failure (HF) remains uncertain. We evaluated the association between in-hospital GDMT intensification and long-term outcomes using data from the multicenter QHEART-R cohort. METHODS AND RESULTS: We analyzed 3,190 patients hospitalized for worsening HF. In-hospital GDMT intensification was quantified by the change in the simple GDMT score from admission to discharge (∆S-GDMT). The primary outcome was a composite of all-cause death or hospitalization for HF (HHF). The mean (±SD) age of the cohort was 77.7±14.0 years, 53% were male, and the mean hospital stay was 20±16 days. The cohort included 1,477 (46%) patients with HF with reduced ejection fraction (HFrEF), 435 (14%) with HF with mildly reduced ejection fraction (HFmrEF), and 1,276 (40%) with HF with preserved ejection fraction. Four-year event-free survival was 32.4% for the primary outcome, 82.5% for cardiovascular (CV) death, and 50.4% for HHF. In patients with HFrEF/HFmrEF, a greater ∆S-GDMT was independently associated with a lower risk of the primary outcome (adjusted hazard ratio 0.90; 95% confidence interval 0.86-0.93; P<0.001), regardless of the number of prior HHF or the simple GDMT score at discharge. CONCLUSIONS: In-hospital GDMT intensification was associated with improved long-term outcomes in patients with HFrEF/HFmrEF. Hospitalization represents a critical opportunity to optimize GDMT and improve prognosis.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 18,
  "authors": [
    {
      "name": "Toru Hashimoto"
    },
    {
      "name": "Ryuichi Matsukawa"
    },
    {
      "name": "Shouji Matsushima"
    },
    {
      "name": "Kayo Misumi"
    },
    {
      "name": "Takeo Fujino"
    },
    {
      "name": "Keisuke Shinohara"
    },
    {
      "name": "Masaki Fujiwara"
    },
    {
      "name": "Shintaro Umemoto"
    },
    {
      "name": "Shun Furusawa"
    },
    {
      "name": "Akihito Ishikita"
    },
    {
      "name": "Kosei Ishimaru"
    },
    {
      "name": "Hiroshi Kisanuki"
    },
    {
      "name": "Masahiro Tokumoto"
    },
    {
      "name": "Tomoaki Yoshitake"
    },
    {
      "name": "Kei Ikuta"
    },
    {
      "name": "Gentaro Taniguchi"
    },
    {
      "name": "Kohtaro Abe"
    },
    {
      "name": "for the QHEART-R Study Group"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5vkmqeq42k76z.bib",
  "cited_by": 0,
  "doi": "10.1253/circj.cj-26-0697",
  "fulltext_url": "https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0697/_article",
  "id": "5vkmqeq42k76z",
  "issns": [
    "1347-4820",
    "1346-9843"
  ],
  "landing_url": "https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0697/_article",
  "language": null,
  "licence": "CC-BY-NC-ND",
  "licence_label": "CC BY-NC-ND",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "jstage-journal",
      "medicine/cardiovascular"
    ],
    [
      "openalex",
      "2705|Heart Failure Treatment and Management"
    ]
  ],
  "openalex": "W7216149822",
  "pdf_url": "https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0697/_pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-03",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/5vkmqeq42k76z.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:17:24Z",
      "native_id": "10.1253/circj.cj-26-0697",
      "source": "jstage",
      "url": "https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0697/_article"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Heart Failure Treatment and Management",
      "subfield": "cardiovascular"
    }
  ],
  "title": "In-Hospital Guideline-Directed Medical Therapy Intensification and Long-Term Outcomes in Patients Hospitalized for Heart Failure in the Current Clinical Paradigm ― Insights From the QHEART-R Study ―",
  "title_text": "In-Hospital Guideline-Directed Medical Therapy Intensification and Long-Term Outcomes in Patients Hospitalized for Heart Failure in the Current Clinical Paradigm ― Insights From the QHEART-R Study ―",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:17:24Z",
  "url": "https://research.draconitic.com/paper/5vkmqeq42k76z",
  "venue": "Circulation Journal",
  "versions": []
}