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 ―
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.
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BibTeX
@article{hashimoto2026inhospital,
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 ―}},
author = {Toru Hashimoto and Ryuichi Matsukawa and Shouji Matsushima and Kayo Misumi and Takeo Fujino and Keisuke Shinohara and Masaki Fujiwara and Shintaro Umemoto and Shun Furusawa and Akihito Ishikita and Kosei Ishimaru and Hiroshi Kisanuki and Masahiro Tokumoto and Tomoaki Yoshitake and Kei Ikuta and Gentaro Taniguchi and Kohtaro Abe and for the QHEART-R Study Group},
journal = {Circulation Journal},
year = {2026},
month = oct,
doi = {10.1253/circj.cj-26-0697},
url = {https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0697/_article},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - 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 ―
AU - Toru Hashimoto
AU - Ryuichi Matsukawa
AU - Shouji Matsushima
AU - Kayo Misumi
AU - Takeo Fujino
AU - Keisuke Shinohara
AU - Masaki Fujiwara
AU - Shintaro Umemoto
AU - Shun Furusawa
AU - Akihito Ishikita
AU - Kosei Ishimaru
AU - Hiroshi Kisanuki
AU - Masahiro Tokumoto
AU - Tomoaki Yoshitake
AU - Kei Ikuta
AU - Gentaro Taniguchi
AU - Kohtaro Abe
AU - for the QHEART-R Study Group
PY - 2026
DA - 2026/10/03
JO - Circulation Journal
DO - 10.1253/circj.cj-26-0697
UR - https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-26-0697/_article
AB - 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.
SN - 1347-4820
SN - 1346-9843
ER -