Abstract Body (Do not enter title and authors here): Purpose: The AHA developed the Get with the Guidelines–Heart Failure (GWTG) program to improve quality of heart failure (HF) care. We compared guideline-directed medical therapy (GDMT) rates among patients with systolic HF between hospitals that joined GWTG versus those that did not.
Methods: This retrospective analysis (2013-2021) included Medicare beneficiaries hospitalized with a principal diagnosis of systolic HF using ICD 9/10 diagnoses. We applied a patient-level interrupted time series model to evaluate the change in outcomes when hospitals joined GWTG compared with hospitals that never participated. The primary analysis assessed immediate change in the outcome (level change), while secondary analyses evaluated change over time (slope change) and a combined model. The primary outcome was a composite GDMT score (range 0-14) incorporating use and dose of beta blockers, renin-angiotensin system inhibitors (RASI), and mineralocorticoid receptor antagonists (MRA). Secondary outcomes included binary indicators for receipt of each medication class and ≥50% target doses. We also assessed HF hospitalization and death at 30 days, 90 days, and 1 year after discharge. We adjusted for sociodemographic factors and comorbidities.
Results: Among 1,274,863 eligible individuals hospitalized for HF, 53.5% (n=681,935) were hospitalized at institutions that had not participated in GWTG and 9.6% (n=122,554) received care at hospitals that joined GWTG prior to patient hospitalization (i.e., GWTG hospital). Median GDMT scores over time were higher in GWTG hospitals compared with non-participating hospitals (Figure 1). In the adjusted analysis, GWTG participation was associated with significantly higher GDMT scores, with an increase in the GDMT score of 0.15 points at both 90 and 180 days (p < 0.001). With the slope model, we found incremental improvements in GDMT scores with longer GWTG hospital participation. Secondary medication outcomes were higher in GWTG hospitals for beta blocker, RASI, and MRA, but not for angiotensin receptor-neprilysin inhibitors (ARNI) (Figure 2). While there were no significant differences in HF hospitalization rates, GWTG participation was associated with a modest but statistically significant reduction in mortality.
Conclusion: Hospital enrollment in GWTG was associated with a significant increase in post-discharge GDMT compared with non-GWTG hospitals. These findings reinforce the value of GWTG-HF as a quality improvement program.