{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T17:35:25Z","timestamp":1793208925860,"version":"4.5.0"},"reference-count":36,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"vor","delay-in-days":112,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Science and Technology Support Plan of China Fund"},{"name":"National High Level Hospital Clinical Research Fund"},{"name":"Capital's Funds for Health Improvement and Research"},{"name":"Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences","id":[{"id":"https:\/\/ror.org\/02drdmm93","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Recent clinical trials have underscored the importance of early initiation of heart failure (HF) guideline-directed medical therapy (GDMT), with growing emphasis on rapid sequencing, particularly after hospitalization for acute HF (AHF). Despite the proven short-term benefit of this approach, few patients receive this therapy at discharge. In patients with AHF, we evaluated whether treatment at discharge with dual sodium\u2013glucose co-transporter-2 inhibitors (SGLT2i)\u2013mineralocorticoid receptor antagonist (MRA) therapy or four-class GDMT was associated with short-term mortality and incremental risk reduction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed two prospective registries of AHF: the China HF-CAP (n = 441 320; main cohort) and the Swedish HF Registry (SwedeHF) (n = 2367; external validation cohort). We assessed the association between discharge prescription of dual therapy SGLT2i and MRA versus neither, and four-class GDMT vs none, with 90-day cardiovascular (CV) and all-cause mortalities, further stratified by baseline serum potassium levels and left ventricular ejection fraction (LVEF) categories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the main cohort, for dual SGLT2i and MRA therapy (n = 71 154) vs neither (n = 81 793) therapy, adjusted odds of 90-day CV and all-cause death were 0.320 [0.283\u20130.361] and 0.504 [0.472\u20130.539], respectively. In the external validation cohort, results were directionally consistent. Association between dual SGLT2i and MRA therapy and short-term survival was consistent irrespective of hyperkalaemia and across HF phenotypes. Further, in the main cohort, adjusted odds of 90-day CV death of four-class GDMT (n = 36 301) were 0.122 (0.106\u20130.14) vs no therapy (n = 18 374).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>After AHF, early initiation of dual SGLT2i and MRA therapy was associated with lower short-term mortality, irrespective of LVEF or potassium levels. Four-class GDMT conferred the lowest risk, emphasizing the importance of timely implementation after AHF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ejhf\/xuag218","type":"journal-article","created":{"date-parts":[[2026,7,19]],"date-time":"2026-07-19T11:33:30Z","timestamp":1784460810000},"page":"738-749","source":"Crossref","is-referenced-by-count":2,"title":["Short-term survival of dual SGLT2i-MRA and four-class guideline-directed medical therapy in acute heart failure"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6356-2284","authenticated-orcid":false,"given":"Jolie","family":"Bruno","sequence":"first","affiliation":[{"name":"Cardiovascular Markers in Stress Condition (MASCOT), Inserm UMR-S 942 , Paris ,","place":["France"]},{"name":"Universit\u00e9 de Paris Cit\u00e9 , Paris ,","place":["France"]},{"name":"Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis et Lariboisi\u00e8re, AP-HP , 2 rue Ambroise Par\u00e9, Paris 75010 ,","place":["France"]},{"name":"Department of Cardiology, Inselspital, Bern University Hospital, University of Bern , Bern ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Xuejuan","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases , Shanghai ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yamei","family":"Xu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases , No. 111 Yixueyuan Road, Xuhui District, Shanghai ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Basile","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Karolinska Institutet , Stockholm ,","place":["Sweden"]},{"name":"National Association of Hospital Cardiologists (ANMCO) Research Center, Heart Care Foundation , Florence ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian","family":"Berge","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Division of Medicine, Akershus University Hospital , L\u00f8renskog ,","place":["Norway"]},{"name":"K.G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew P","family":"Ambrosy","sequence":"additional","affiliation":[{"name":"Kaiser Permanente San Francisco Medical Center , San Francisco, CA ,","place":["USA"]},{"name":"Division of Research, Kaiser Permanente Northern California , Pleasanton, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7732-0887","authenticated-orcid":false,"given":"Gianluigi","family":"Savarese","sequence":"additional","affiliation":[{"name":"Department of Clinical Science and Education, S\u00f6dersjukhuset, Karolinska Institutet , Stockholm ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhonglei","family":"Xie","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases , No. 111 Yixueyuan Road, Xuhui District, Shanghai ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiatong","family":"Cui","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases , No. 111 Yixueyuan Road, Xuhui District, Shanghai ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanyan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases , No. 111 Yixueyuan Road, Xuhui District, Shanghai ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences , No. 16 Nanxiao Street, Dongzhimen, Dongcheng District, Beijing 100700 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinli","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University , Jiangsu ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yugang","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Center for Translational Medicine, Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-sen University , Guangzhou ,","place":["China"]},{"name":"NHC Key Laboratory of Assisted Circulation (Sun Yat-sen University) , Guangzhou ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuhua","family":"Liao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Union Hospital Affiliated to Tongji, Medical College of Huazhong University of Science and Technology , Hubei ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weimin","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiology, First Affiliated Hospital of Harbin Medical University , Heilongjiang ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9360-7332","authenticated-orcid":false,"given":"Junbo","family":"Ge","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases , No. 111 Yixueyuan Road, Xuhui District, Shanghai ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2273-4860","authenticated-orcid":false,"given":"Jiefu","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences , No. 16 Nanxiao Street, Dongzhimen, Dongcheng District, Beijing 100700 ,","place":["China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8715-7753","authenticated-orcid":false,"given":"Alexandre","family":"Mebazaa","sequence":"additional","affiliation":[{"name":"Cardiovascular Markers in Stress Condition (MASCOT), Inserm UMR-S 942 , Paris ,","place":["France"]},{"name":"Universit\u00e9 de Paris Cit\u00e9 , Paris ,","place":["France"]},{"name":"Department of Anesthesiology, Critical Care and Burn Unit, University Hospitals Saint-Louis et Lariboisi\u00e8re, AP-HP , 2 rue Ambroise Par\u00e9, Paris 75010 ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingmin","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zhongshan Hospital, Fudan University, 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