AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Quadruple GDMT Reduces 30-Day Heart Failure Readmission in Real-World: SGLT2i Underutilisation Drives the Implementation Gap
By Patel D, Alhaque Roomi MHA, Babu S et al.
Introduction: Contemporary European registries report quadruple GDMT achievement of 44-66% in chronic HFrEF, yet real-world US community discharge prescribing patterns remain poorly characterised. SGLT2 inhibitors carry Class I indication across the HF spectrum with proven cardiorenal benefit. Paradoxically, CKD patients who stand to benefit most often receive SGLT2i less frequently. Hypothesis: Quadruple GDMT at hospital discharge reduces 30-day readmission, with CKD-related SGLT2i underutilisation representing a key modifiable barrier to optimisation. Methods: Retrospective analysis of 168 consecutive HF admissions at a teaching hospital in the greater Philadelphia region (2024-2025). GDMT prescription rates assessed at discharge. CKD defined as eGFR<60 mL/min/1.73m ² or documented diagnosis. Primary outcome: 30-day all-cause readmission. Secondary analysis: SGLT2i prescription by CKD status and creatinine category. Results: Mean age 72±13 years; 49% female; 50% HFrEF; 45% CKD (n=75). Discharge GDMT: beta-blockers 75%, ACEi/ARB/ARNI 69%, SGLT2i 49%, MRA 39%. Quadruple therapy: 13.1%, below registry benchmarks (44-66%). 30-day readmission: quadruple therapy 31.8% vs incomplete GDMT 56.2% (ARR=24.3%, NNT=4.1, RRR=43%). SGLT2i prescription was markedly lower in CKD: 17.3% vs 49.5% non-CKD (p<0.0001). By creatinine: Cr<1.2: 39.7%, Cr 1.2-2.0: 41.7%, Cr>2.0: 17.5% (p=0.027). Diabetes did not influence prescribing (DM 38.2% vs non-DM 31.6%, p=0.47), confirming CKD status drove SGLT2i decisions. Limitations: Patients tolerating quadruple therapy may represent a more stable phenotype with inherently lower readmission risk, representing potential confounding by indication. Conclusions: Quadruple GDMT at discharge was associated with 43% lower readmission (NNT=4.1), though causality cannot be established. CKD patients were 3-fold less likely to receive SGLT2i despite Class I indication. Targeting SGLT2i initiation in CKD represents a high-yield optimisation opportunity, though more large population based prospective studies would be needed.