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Efficacy of guideline‐directed medical treatment in heart failure with mildly reduced ejection fraction

Zhang, Xinxin, Sun, Yuxi, Zhang, Yunlong, Wang, Ning, Sha, Qiuyan, Yu, Songqi, Lv, Xin, Ding, Zijie, Zhang, Yanli, Tse, Gary, and others. (2023) Efficacy of guideline‐directed medical treatment in heart failure with mildly reduced ejection fraction. ESC Heart Failure, 10 (2). pp. 1035-1042. ISSN 2055-5822. (doi:10.1002/ehf2.14199) (KAR id:99191)


Aims: Heart failure with mildly reduced ejection fraction (HFmrEF) has received increasing attention following the publication of the latest ESC guidelines in 2021. However, it remains unclear whether patients with HFmrEF could benefit from guideline‐directed medical treatment (GDMT), referring the combination of ACEI/ARB/ARNI, β‐blockers, and MRAs, which are recommended for those with reduced ejection fraction. This study explored the efficacy of GDMT in HFmrEF patients. Methods: This was a retrospective cohort study of HFmrEF patients admitted to The First Affiliated Hospital of Dalian Medical University between 1 September 2015 and 30 November 2019. Propensity score matching (1:2) between patients receiving triple‐drug therapy (TT) and non‐triple therapy (NTT) based on age and sex was performed. The primary outcome was all cause death, cardiac death, rehospitalization from any cause, and rehospitalization due to worsening heart failure. Results: Of the 906 patients enrolled in the matched cohort (TT group, n = 302; NTT group, N = 604), 653 (72.08%) were male, and mean age was 61.1 ± 11.92. Survival analysis suggested that TT group experienced a significantly lower incidence of prespecified primary endpoints than NTT group. Multivariable Cox regression showed that TT group had a lower risk of all‐cause mortality (HR 0.656, 95% CI 0.447–0.961, P = 0.030), cardiac death (HR 0.599, 95% CI 0.380–0.946, P = 0.028), any‐cause rehospitalization (HR 0.687, 95% CI 0.541–0.872, P = 0.002), and heart failure rehospitalization (HR 0.732, 95% CI 0.565–0.948, P = 0.018). Conclusions: In patients with HFmrEF, combined use of neurohormonal antagonists produces remarkable effects in reducing the occurrence of the primary outcome of rehospitalization and death. Thus, the treatment of HFmrEF should be categorized as HFrEF due to the similar benefit of neurohormonal blocking therapy in HFrEF and HFmrEF.

Item Type: Article
DOI/Identification number: 10.1002/ehf2.14199
Uncontrolled keywords: Heart failure with mildly reduced ejection fraction, Neurohormonal blocking therapy, Triple therapy, Guideline‐directed medical treatment
Subjects: R Medicine
Divisions: Divisions > Division of Natural Sciences > Kent and Medway Medical School
Funders: National Natural Science Foundation of China (
SWORD Depositor: JISC Publications Router
Depositing User: JISC Publications Router
Date Deposited: 16 Dec 2022 13:00 UTC
Last Modified: 04 Mar 2024 19:47 UTC
Resource URI: (The current URI for this page, for reference purposes)

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