Efficacy of guideline‐directed medical treatment in heart failure with mildly reduced ejection fraction

Aims Heart failure with mildly reduced ejection fraction (HFmrEF) has received increasing attention following the publication of the latest ESC guidelines in 2021. However, it remains unclear whether patients with HFmrEF could bene ﬁ t from guideline-directed medical treatment (GDMT), referring the combination of ACEI/ARB/ARNI, β -blockers, and MRAs, which are recommended for those with reduced ejection fraction. This study explored the ef ﬁ cacy of GDMT in HFmrEF patients. Methods This was a retrospective cohort study of HFmrEF patients admitted to The First Af ﬁ liated Hospital of Dalian Medical University between 1 September 2015 and 30 November 2019. Propensity score matching (1:2) between patients receiving triple-drug therapy (TT) and non-triple therapy (NTT) based on age and sex was performed. The primary outcome was all cause death, cardiac death, rehospitalization from any cause, and rehospitalization due to worsening heart failure. Results Of the 906 patients enrolled in the matched cohort (TT group, n = 302; NTT group, N = 604), 653 (72.08%) were male, and mean age was 61.1 ± 11.92. Survival analysis suggested that TT group experienced a signi ﬁ cantly lower incidence of prespeci ﬁ ed primary endpoints than NTT group. Multivariable Cox regression showed that TT group had a lower risk of all-cause mortality (HR 0.656, 95% CI 0.447 – 0.961, P = 0.030), cardiac death (HR 0.599, 95% CI 0.380 – 0.946, P = 0.028), any-cause rehospitalization (HR 0.687, 95% CI 0.541 – 0.872, P = 0.002), and heart failure rehospitalization (HR 0.732, 95% CI 0.565 – 0.948, P = 0.018).