(126) Optimal Timing of GDMT for Cardiogenic Shock Patients With Impella

Introduction: The 2022 Heart Failure Management Guidelines in American College of Cardiology/American Heart Association (ACC/AHA) strongly recommend the gradual introduction of GDMT (guideline-directed medical therapy) in stages C and D of heart failure (HF) with reduced ejection fraction (HFrEF). The guidelines emphasize the continuous optimization of GDMT, including agents such as renin–angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, and sodium–glucose transporter 2 inhibitors. The efficacy of GDMT has been demonstrated not only in HFrEF patients but also in those with cardiogenic shock. However, fully implementing GDMT in clinical practice remains challenging. To address this, Matsukawa et al. developed a simplified GDMT score based on the dosages of GDMT drugs. They reported that a regimen with a simple GDMT score ≥5 improved prognosis in HF patients. Nevertheless, the optimal timing for introducing GDMT in patients with cardiogenic shock remains unclear. Therefore, this study aims to evaluate the effectiveness of initiating GDMT during the acute phase, prior to intensive care unit (ICU) discharge, in cardiogenic shock patients with Impella®.

Methods: This study was a two hospitals retrospective study in Japanese ICUs. From April 2019 to June 2024, 40 cardiogenic shock patients with impella🄬 were enrolled and divided into two groups based on their simple GDMT scores (≥3 or < 3) at ICU discharge. We compared the 6-month composite outcomes (death and heart failure readmission). Additionally, we analyzed the simple GDMT scores at hospital discharge for both groups.

Results: The group with a simple GDMT score ≥3 at ICU discharge showed significantly improved composite outcomes (p < 0.05). Furthermore, compared to the low-score group, this group had significantly higher simple GDMT scores at hospital discharge (5.48±1.93 versus 1.94±1.95, p< 0.05) and a greater proportion of patients with a simple GDMT score ≥5 (90% versus 10%, p< 0.05).

Conclusions: Introducing GDMT from the acute phase, prior to ICU discharge, may lead to achieving sufficient GDMT implementation at hospital discharge and potentially improve prognosis for cardiogenic shock patients with impella🄬.