Background: Achieving optimized guideline directed medical therapy (GDMT) is recommended in patients undergoing transcatheter mitral-valve edge-to edge-repair (M-TEER). However, up to date there is no way to quantitatively measure GDMT quality. We therefore aimed to validate a simple score for assessing the quality of GDMT in patients with heart failure with reduced ejection fraction (HFrEF) undergoing M-TEER. 

Methods: We included patients from the EuroSMR Registry who underwent M-TEER and had complete data regarding GDMT at both baseline and 6-month follow-up. The GDMT score is based on trial uptitration schemes and is shown in Figure 1. The primary outcome was a composite of all-cause death and/or HF hospitalization. 

Results: Among the 1641 EuroSMR patients, 880 had full datasets regarding GDMT and were included in the present study. Median GDMT score was 4 points (interquartile range 3 to 6). The GDMT score was separated in three domains (ACE/AT-1 inhibitors and ARNIs, beta-blockers and mineralocorticoid receptor blockers), the scoring system was significantly associated with the primary outcome in all three domains (Figure 1). Interestingly standardized regression coefficients showed high similarities between domains (β -0.142, -0.146 and -0.132 respectively). The overall GDMT score was also significantly associated with the primary outcome (HR 0.90, 95% CI 0.85 to 0.95, β -0.107). At 6-months the change of the GDMT score was assessed. Reassuringly improvements of the GDMT score at 6-months were associated with an improved cardiovascular outcome (HR 0.87, 95% CI 0.82 to 0.93). 

Conclusions: We for the first time present a score, which allows to quantitatively measure the quality of GDMT in HFrEF patients undergoing M-TEER. This score can be used in the future to guide trial design and help with clinical decision making.