BACKGROUND Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) remains underused. Acute heart failure (HF) hospitalization represents a critical opportunity for rapid initiation of evidence-based medications. However, data on GDMT use at discharge are mostly derived from national quality improvement registries. OBJECTIVES This study aimed to describe contemporary GDMT use patterns across HF hospitalizations at community-based health systems. METHODS The authors identified HF hospitalizations from 2016 to 2022 in a U.S. database aggregating deidentified electronic health record data from more than 30 health systems. In-hospital and discharge rates of GDMT use were reported for eligible HFrEF patients. Factors associated with inpatient GDMT use and predischarge discontinuation were evaluated with the use of multivariable models. RESULTS A total of 20,387 HF hospitalizations among 13,729 HFrEF patients were identified. Renin-angiotensin system inhibitors, beta-blockers, and mineralocorticoid receptor antagonists were administered during 70%, 86%, and 37% of eligible hospitalizations, respectively. Angiotensin receptor-neprilysin inhibitors and sodium-glucose cotransporter 2 inhibitors were used in 17% and 8% of eligible hospitalizations, respectively. Discharge GDMT rates were low. Triple/quadruple therapy was administered in 26% of hospitalizations, falling to 14% on discharge. Predischarge GDMT discontinuations were associated with inpatient hypotension, hyperkalemia, and worsening renal function, but 43%-57% had no medical contraindications. In adjusted analyses, use of 3 or more GDMT classes was associated with fewer 90-day all-cause deaths and HF readmissions compared with less comprehensive GDMT. CONCLUSIONS Inpatient GDMT use in a national analysis of HF hospitalizations was lower than reported in quality improvement registries. High discontinuation rates emphasize an unmet need for inpatient and postdischarge strategies to optimize GDMT use.

中文翻译：

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社区卫生系统心力衰竭住院期间住院患者使用指南指导的药物治疗。


背景 针对射血分数降低的心力衰竭 (HFrEF) 的指南指导药物治疗 (GDMT) 仍未得到充分利用。急性心力衰竭（HF）住院治疗是快速开始循证药物治疗的关键机会。然而，出院时 GDMT 使用的数据主要来自国家质量改进登记处。目标 本研究旨在描述社区卫生系统中心力衰竭住院治疗中当代 GDMT 的使用模式。方法 作者在美国数据库中确定了 2016 年至 2022 年心力衰竭住院情况，该数据库汇总了来自 30 多个卫生系统的去识别化电子健康记录数据。报告了符合条件的 HFrEF 患者的住院和出院 GDMT 使用率。使用多变量模型评估与住院患者 GDMT 使用和出院前停药相关的因素。结果 在 13,729 名 HFrEF 患者中，总共确定了 20,387 名 HF 住院患者。在符合条件的住院治疗中，肾素-血管紧张素系统抑制剂、β-受体阻滞剂和盐皮质激素受体拮抗剂的使用率分别为 70%、86% 和 37%。符合条件的住院治疗中，血管紧张素受体-脑啡肽酶抑制剂和钠-葡萄糖协同转运蛋白 2 抑制剂的使用率分别为 17% 和 8%。出院 GDMT 率较低。 26% 的住院患者接受了三联/四联疗法，出院后这一比例降至 14%。出院前停止 GDMT 与住院患者低血压、高钾血症和肾功能恶化有关，但 43%-57% 的患者没有医疗禁忌症。在调整后的分析中，与不太全面的 GDMT 相比，使用 3 个或更多 GDMT 类别与较少的 90 天全因死亡和心力衰竭再入院相关。 结论 全国心力衰竭住院分析中住院患者 GDMT 的使用率低于质量改进登记中报告的水平。高停药率强调了住院和出院后优化 GDMT 使用策略的需求未得到满足。