868-P: Newer Guideline-Directed Medical Therapies (GDMT) Are Underutilized in 2021 in Patients with Heart Failure with or without Diabetes

Abstract

Heart failure (HF) affects ∼40% of patients with diabetes. In 2021, guidelines endorsed newer therapies such as angiotensin receptor-neprilysin inhibitors (ARNI) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) as first-line medications to improve clinical outcomes. Methods: We examined GDMT using claims data in a large health system which provides both rural and urban care. Patients with HF encounters during the 12 months preceding 18Dec2021 were extracted from the Univ of Colorado health system (UCHealth) TriNetX database. GDMT use was compared by chi square. Results: Among 10170 patients with HF encounters, 3356 (33%) had reduced (HFrEF) and 2980 (29%) preserved ejection fraction (HFpEF) , 13% mixed and 25% other types or unspecified HF. Mean age was 71±14y, 45% were female, 8% Black, 10% Latino; 43% had T2D and 44% eGFR<59. Older GDMT such as beta-blockers and RAASi were widely prescribed (Figure) ; patients with T2D were more likely to receive ACEi/ARB and those with HFpEF and T2D were more likely to receive beta blockers. In contrast, use of ARNI and SGLT2i was less frequent. Patients with T2D were more likely to receive SGLT2i than those without T2D.Conclusion: Demographic and clinical characteristics were consistent with the US population. ARNI and SGLT2i use even in 2021 was infrequent among patients with HF; SGLT2i use was particularly low in those without T2D. Disclosure M.Canonico: Research Support; Lexicon Pharmaceuticals, Inc. J.Hsia: Research Support; Abbott, Agios, Inc., Alexion Pharmaceuticals, Inc., Alnylam Pharmaceuticals, Inc., Amgen Inc., Angionetics, Arca Biopharma, Array BioPharma Inc., AstraZeneca, Atentiv, Audentes, Bayer AG, Better Therapeutics, Bristol-Myers Squibb Company, Cardiol Therapeutics, CellResearch, Cook Medical, CSL Behring, Eidos Therapeutics, Inc., EP Trading Company, ESPERION Therapeutics, Inc., Everlywell, Inc., Faraday, Fortress Biotech, Inc., HDL Therapeutics, HeartFlow, Hummingbird Bioscience, Insmed, Janssen Research & Development, LLC, Kowa Research Institute, Inc., Lexicon Pharmaceuticals, Inc., Medtronic, Merck & Co., Inc., Moderna, Inc., Novate Medical, Novo Nordisk, Pfizer Inc., PhaseBio Pharmaceuticals, Inc., PPD Inc., Prothena, Regeneron Pharmaceuticals Inc., Regio Biosciences, Sanifit, Sanofi, Smith+Nephew, Stealth BioTherapeutics, Wraser, Stock/Shareholder; AstraZeneca. C.P.Cannon: Advisory Panel; Alnylam Pharmaceuticals, Inc., Amarin Corporation, Amgen Inc., Amryt Pharma Plc, Applied Therapeutics, Ascendis Pharma A/S, Boehringer Ingelheim International GmbH, Bristol-Myers Squibb Company, Eli Lilly and Company, Janssen Pharmaceuticals, Inc., Lexicon Pharmaceuticals, Inc., Merck & Co., Inc., Pfizer Inc., Rhoshan, Sanofi, Research Support; Amgen Inc., Better Therapeutics, Boehringer Ingelheim International GmbH, Bristol-Myers Squibb Company, Daiichi Sankyo, Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novo Nordisk, Pfizer Inc. M.P.Bonaca: Consultant; Audentes, Other Relationship; CPC Clinical Research, Stock/Shareholder; Medtronic, Pfizer Inc., Vertex Pharmaceuticals Incorporated.