Abstract
BACKGROUND: Hospitalization-related costs for heart failure (HF) are a major contributor to the overall health care expenditure in the United States. Despite recommendations, guideline-directed medical therapy (GDMT) is underutilized at discharge in eligible patients, likely contributing to high readmission rates. Describing the effect of GDMT use at discharge may better inform institutions on the value of implementing focused therapy initiatives. OBJECTIVES: This study aimed to examine the association between the number of active GDMT prescriptions at discharge and 30-day readmissions. METHODS: This retrospective cohort study analyzed 2,121 index hospitalizations for HF across 5 institutions from February 1, 2021, to October 31, 2024. Patients included were adults with a baseline left ventricular ejection fraction ≤40%. The primary outcome was 30-day all-cause readmission, and the secondary outcome was 30-day HF readmission. Multivariable mixed-effects Cox proportional hazard models were used to assess the association between GDMT count and readmission rates. RESULTS: Increased GDMT count at discharge was associated with significantly lower hazard of 30-day all-cause readmission: 1 vs 2 GDMT (HR: 0.79; 95% CI: 0.64-0.97), 1 vs 3 GDMT (HR: 0.70; 95% CI: 0.55-0.90), and 1 vs 4 GDMT (HR: 0.56; 95% CI: 0.40-0.77). Trends were similar for HF-specific readmissions. CONCLUSIONS: Increasing number of GDMT classes prescribed at discharge was associated with a gradient reduction in 30-day all-cause and HF readmissions, with a stronger effect seen with higher GDMT counts. Implementing comprehensive GDMT strategies at discharge may reduce health care costs and enhance institutional performance under national quality metrics.