Abstract 10031: Gaps in Medical Therapy for Patients with Heart Failure and Reduced Ejection Fraction (HFrEF) in a Large, Diverse, Electronically Identified Cohort

Abstract

Background: National registries reveal significant gaps in medical therapy for patients with heart failure and reduced ejection fraction (HFrEF), but may not completely capture the population eligible for therapy. We developed an electronic health record-based algorithm to identify eligible HFrEF patients, and used this to assess prescribing in a large, diverse, urban health system. Methods: In this cross-sectional study of NYU Langone Health outpatients (>350 sites) with EF≤40% on echocardiogram and clinic visit from 3/1/2019-2/29/2020, we assessed contraindication to and prescription of the following: beta-blocker (BB), angiotensin converting enzyme inhibitor (ACE-I)/angiotensin receptor blocker (ARB)/angiotensin receptor neprilysin inhibitor (ARNI), and mineralocorticoid receptor antagonist (MRA). Results: We electronically identified 2,732 patients for analysis. Among those eligible for each medication class, 84.8% and 79.7% were appropriately prescribed BB and ACE-I/ARB/ARNI, respectively, while only 23.9% and 22.7% were appropriately prescribed MRA and ARNI, respectively. In adjusted models (Table), younger age, cardiology visit, and lower EF were associated with increased prescribing. Medicaid insurance was associated with increased prescribing of ARNI and Black race with prescribing of MRA. Conclusions: We observed significant gaps in MRA and ARNI therapy for HFrEF patients. Medicaid insurance was associated with increased ARNI use, possibly due to lack of prior authorization requirements under New York State Medicaid policy. Our findings support system- and policy-level interventions to increase use of these life-saving therapies.