Go to content

Intensity of guideline-directed medical therapy for coronary heart disease and ischemic heart failure outcomes


Aims — The impact of guideline-directed medical therapy for coronary heart disease in those with hospitalized acute heart failure is unknown.

Methods — We studied guideline-directed medical therapies for coronary disease: ACE inhibitors or ARBs, beta-adrenoreceptor antagonists, antiplatelet agents and/or anticoagulants, and statins. Using inverse probability of treatment weighting using the propensity score, we examined associations of guideline-directed medical therapy intensity (categorized as low [0-1], high [2-3], or very high [4] number of drugs) with mortality in 1873 patients with angina, troponin elevation or prior myocardial infarction.

Results — At discharge, 0-1, 2-3, and 4 medications were prescribed in 467 (25%), 705 (38%), and 701 (37%), respectively. Relative to those prescribed 0-1 drugs (reference), all-cause mortality was lower with 2-3 (hazards ratio [HR] 0.48; 95%CI; 0.28-0.84, p=0.009) or all 4 drug classes (HR 0.56; 95%CI; 0.33-0.96, p=0.034) over 181-365 days, with similar reductions present from 0-180 days. In those with heart failure with preserved ejection fraction, mortality trended lower with 2-3 drug classes (HR 0.43; 95%CI; 0.18-1.02, p=0.054) and was significantly reduced with 4 drugs (HR 0.32; 95%CI; 0.12-0.84, p=0.021) during 0-180 day follow-up. In heart failure with reduced ejection fraction, all-cause mortality was reduced during both 0-180 and 181-365 day periods when discharged on 2-3 (HR 0.30 for 181-365 days; 95%CI; 0.14-0.64, p=0.002) or all 4 drug classes (HR 0.43; 95%CI; 0.19-0.95, p=0.038).

Conclusions — Increasing guideline-directed medical therapy intensity for coronary heart disease resulted in lower mortality in patients with acute ischemic heart failure with both preserved and reduced ejection fractions.



Crosier R, Austin PC, Ko DT, Lawler PR, Stukel TA, Farkouh ME, Wang X, Spertus JA, Ross HJ, Lee DS. Am J Med. 2020; 134(5):672-81.e4. Epub 2020 Nov 9.

View Source

Research Programs

Associated Sites