Assessment of Guideline-Directed Medical Therapy Optimization Scores and Readmission Risk in Heart Failure With Reduced Ejection Fraction

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BACKGROUND: Heart failure with reduced ejection fraction carries high morbidity and mortality. Guideline-directed medical therapy (GDMT) improves outcomes, yet real-world use is often suboptimal. Multiple scoring tools quantifying GDMT optimization have been developed to identify areas of improvement, including GDMT count, Optimal Medical Therapy (OMT), modified OMT (mOMT), and Kansas City Medical Optimization (KCMO) scores. Their clinical utility in predicting readmissions is uncertain. OBJECTIVE: To evaluate the association between four GDMT scoring systems and 30- and 90-day heart failure (HF) readmissions. METHODS: This multi-center, retrospective cohort study included adults with a left-ventricular ejection fraction ≤40% hospitalized for HF across five academic medical centers between February 2021 and July 2023. Patients discharged on ≥1 GDMT class with ≥1 healthcare encounter within 90 days were included. GDMT scores were calculated at discharge, and their associations with 30- and 90-day HF readmissions were analyzed using mixed-effects Cox proportional hazards models adjusted for clinical covariates. RESULTS: Among 544 patients, 13.1% experienced 30-day and 26.8% experienced 90-day HF readmissions. At 30 days, no GDMT score was significantly associated with readmission. At 90 days, higher OMT (hazard ratios [HR]: 0.93, 95% CI: 0.86-0.99) and mOMT (HR: 0.94, 95% CI: 0.88-0.99) scores were associated with lower readmission risk, whereas GDMT count and KCMO scores were not. Patients on minimal GDMT regimens contributed disproportionately to 90-day readmissions. CONCLUSION AND RELEVANCE: In this multi-center cohort, OMT and mOMT scores, but not GDMT count or KCMO, were associated with 90-day HF readmissions. Findings highlight the potential utility of simpler GDMT scoring systems while underscoring the need for refined tools incorporating dose intensity, class-specific weighting, and longitudinal therapy to better guide optimization efforts.

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