ESC Congress 2026 Abstract · Oct 26, 2026
Guideline-directed medical therapy and outcomes in frail patients with HFrEF and low blood pressure : insights from the JROADHF-NEXT
By Nagumo S, ebato M, Tohyama T et al.
Background: Low blood pressure (BP) and frailty are major barriers to guideline-directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF). Data on GDMT utilization and its prognostic impact in frail patients with HFrEF and low BP remain limited. Purpose: To investigate prescription patterns of GDMT and assess whether contemporary GDMT is associated with clinical outcomes in frail patients with HFrEF and low BP. Methods: From the JROADHF-NEXT database, we analyzed patients hospitalized for acute HF with left ventricular ejection fraction <40%, discharge systolic BP ≤100 mmHg, and Clinical Frailty Scale (CFS) score 4–7. Patients were categorized into three groups according to discharge GDMT: group 1, ACE-I/ARB/ARNI + β-blocker + MRA + SGLT2-I; group 2, ACE-I/ARB/ARNI + β-blocker; and group 3, others. The primary outcome was all-cause mortality, and the secondary outcome was cardiovascular death. Results: A total of 382 patients were included (mean age 69 ± 14 years; 68% male; median CFS 4 [IQR 4–5]). Mean discharge BP was 90 ± 7 mmHg and increased to 107 ± 21 mmHg at 12 months. At discharge, ACEI/ARB/ARNI, β-blockers, MRAs, and SGLT2-Is were prescribed in 78%, 91%, 79%, and 26% of patients, respectively, and continued in 78%, 89%, 73%, and 34% at 12 months. The contemporary GDMT (Group 1) was prescribed in 69 patients (18%), whereas conventional GDMT (Group 2) was prescribed in 194 patients (51%). During a median follow-up of 1.95 years, 100 patients (26%) died. Compared with group 1, adjusted HRs for all-cause mortality were 1.67 (95% CI 0.82–3.44, p=0.159) in group 2 and 2.63 (95% CI 1.28–5.43, p=0.009) in group 3; for cardiovascular death, the corresponding HRs were 2.00 (95% CI 0.73–5.50, p=0.175) and 3.95 (95% CI 1.47–10.6, p=0.007), respectively. Conclusion: In frail patients with HFrEF and low BP, contemporary GDMT was associated with improved clinical outcomes.