Study Reveals High Variability in Hospital GDMT Scores, Outcomes, Costs

Hospitals that score higher on a composite measure of guideline-directed medical therapy (GDMT) for patients with heart failure tend to have better patient outcomes, according to a new study published in JAMA Cardiology.¹ These outcomes include reduced mortality, fewer rehospitalizations, lower health care costs, and an often overlooked aspect of a patient’s quality of life: more time spent at home instead of the hospital.

Conducted as a retrospective cohort analysis of the American Heart Association’s Get With the Guidelines–Heart Failure Registry, the study evaluated 360 hospitals across the US between 2015 and 2019, including data from more than 41,000 patients treated for heart failure with reduced ejection fraction (HFrEF). Researchers developed a GDMT score that reflected how well hospitals adhered to prescribing evidence-based heart failure treatments at discharge, based on the percentage of eligible medications prescribed to each patient.

The study revealed substantial variability in hospital performance, including:

• GDMT score at discharge (adjusted median odds ratio [AMOR], 1.23; 95% CI, 1.21-1.26)
• Patient mortality (AMOR, 1.17; 95% CI, 1.14-1.24)
• Heart failure rehospitalization (AMOR, 1.22; 95% CI, 1.18-1.27)
• 90-day mortality or heart failure rehospitalization, collectively (AMOR, 1.21; 95% CI, 1.18-1.26)
• Time at home (AMOR, 1.07; 95% CI, 1.06-1.10)
• Costs (AMOR, 1.23; 95% CI, 1.21-1.26)

On a scale of 0 to 1, GDMT scores ranged from 0.39 to 0.94 across hospitals, with a median (IQR) score of 0.66 (0.58-0.73). Hospitals with higher GDMT scores were more commonly found in urban areas, had larger numbers of beds, and reported better patient outcomes. These hospitals saw lower mortality rates, fewer combined cases of death or rehospitalization within 90 days of discharge, and their patients spent more time at home postdischarge, a key indicator of improved quality of life.

Hospitals with higher GDMT scores had better patient outcomes, with lower mortality rates and costs | Image credit: merrimonc – stock.adobe.com

Two thirds of the included patients were insured by Medicare, and the analysis also showed that hospitals with better GDMT scores incurred lower Medicare-related costs, which ranged from $7378 to $51,395 with a median (IQR) of $15,261 (13,006-19,083). This is a key finding as the health care system looks to balance clinical outcomes with cost-effective care.

According to the study authors, these findings show that improving GDMT adherence at discharge could save lives and lower the burden on health care systems, stressing that GDMT optimization should be included in efforts to improve health care value.

“Associations between facility variation in the use of GDMT and hospital-level variations in the clinical outcomes suggest that optimization of HF [heart failure] medical therapy at the time of hospital discharge and the early postdischarge period should be a central focus of quality improvement efforts,” the authors said. “The observed variability in the use of GDMT suggests that there is considerable room for improvement in this regard.”

Another major finding was that women, Black patients, and patients under Medicare were more likely to be discharged from hospitals with a GDMT score below 0.58, which was the lowest quartile in the study. These patients faced higher risks of mortality and rehospitalization, highlighting a persistent disparity in health care access and quality.

Earlier in 2024, research showed that women with HFrEF were less likely to receive GDMT compared with men.² Specifically, 81.1% of women received any GDMT within 12 months compared with 84.5% of men with HFrEF.

“Implementation program process measures may include documentation of next steps in the optimal use of GDMT in the medical record focusing first on HF medication class initiation followed by HF medication uptitration, multidisciplinary collaboration, and early follow-up after discharge,” the analysis authors said.¹ “Special attention should be paid to women, Black patients, and patients with Medicare insurance owing to comparatively low GDMT use observed in the current and other analyses.”

References

1. Polsinelli VB, Sun JL, Greene SJ, et al. Hospital heart failure medical therapy score and associated clinical outcomes and costs. JAMA Cardiol. Published online September 25, 2024. doi:10.1001/jamacardio.2024.2969
2. McNulty R. Female patients less likely to receive guideline-directed HFrEF therapies vs males. AJMC®. January 25, 2024. Accessed September 25, 2024. https://www.ajmc.com/view/female-patients-less-likely-to-receive-guideline-directed-hfref-therapies-vs-males