Trial reportCirculation. Heart failure2023
Economic Modeling Analysis of an Intensive GDMT Optimization Program in Hospitalized Heart Failure Patients.
Trial report in Circulation. Heart failure, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed, 20 citations in OpenAlex.
- The Impact of a Remote Patient Care Program on Health Care Costs and Utilization Among Medicare Patients With Chronic Disease.Mayo Clinic proceedings. Innovations, quality & outcomes · 2026Article
- A contemporary review on heart failure with improved ejection fraction.NPJ cardiovascular health · 2025Review
- Hospitalizations and inpatient resource consumption of patients suffering from chronic disease - Past trend and forecast for Switzerland.BMC health services research · 2025Article
- A Fixed-Dose Solution for a Complex Problem: Can Polypills and Implementation Science Improve GDMT Uptake in HFrEF?JACC. Advances · 2025Article
- Comparison of Quadruple Therapy Sequencing Strategies for Heart Failure With Reduced Ejection Fraction.Journal of the American Heart Association · 2025Article
- A Review of Heterogeneity in Comparative Economic Analysis, with Specific Considerations for the Decentralized US Setting and Patient-Centered Care.PharmacoEconomics · 2025Review
- Treatment Pattern of Heart Failure Patients in Sweden During 2021-2023 in Relation to Updated Treatment Recommendations.Drugs - real world outcomes · 2025Article
- Initiation and sequencing of guideline-directed medical therapy for heart failure across the ejection fraction spectrum.Heart failure reviews · 2025Review
Corrections and comments
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Authors and funding
4 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundThe STRONG-HF trial (Safety, Tolerability and Efficacy of Up-Titration of Guideline-Directed Medical Therapies for Acute Heart Failure) demonstrated substantial reductions in the composite of mortality and morbidity over 6 months among hospitalized patients with heart failure (HF) who were randomized to intensive guideline-directed medical therapy (GDMT) optimization compared with usual care. Whether an intensive GDMT optimization program would be cost-effective for patients with HF with reduced ejection fraction is unknown.
methodsUsing a 2-state Markov model, we evaluated the effect of an intensive GDMT optimization program on hospitalized patients with HF with reduced ejection fraction. Two population models were created to simulate this intervention, a clinical trial model, based on the participants in the STRONG-HF trial, and a real-world model, based on the Get With The Guidelines-HF registry of patients admitted with worsening HF. We then modeled the effect of a 6-month intensive triple therapy GDMT optimization program comprised of cardiologists, clinical pharmacists, and registered nurses. Hazard ratios from the intervention arm of the STRONG-HF trial were applied to both population models to simulate clinical and financial outcomes of an intensive GDMT optimization program from a US health care sector perspective with a lifetime time horizon. Optimal quadruple GDMT use was also modeled.
resultsAn intensive GDMT optimization program was extremely cost-effective with incremental cost-effectiveness ratios <$10 000 per quality-adjusted life-year in both models. Optimal quadruple GDMT implementation resulted in the most gains in life-years with incremental cost-effectiveness ratios of $60 000 and $54 000 in the clinical trial and real-world models, respectively.
conclusionsAn intensive GDMT optimization program for patients hospitalized with HF with reduced ejection fraction would be cost-effective and result in substantial gains in clinical outcomes, especially with the use of optimal quadruple GDMT. Clinicians, payers, and policymakers should prioritize the creation of such programs.
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