Abstract 10632: Variation in the Association Between Beta Blocker and/or Rasi Use After Discharge and Outcomes in Hfref by Age

Abstract

Introduction: Given the increasing age and comorbidity burden of HFrEF patients, there are questions regarding whether the net risk/benefit of guideline directed medical therapy (GDMT) varies across the age spectrum. The aim of this study was to use Get With The Guidelines-Heart Failure data linked with Medicare claims to determine whether the association between selected GDMT and outcomes in HFrEF varies across the age spectrum. Methods: We identified 48,711 eligible patients from 330 different centers admitted with HFrEF between 2008 and 2016 using GWTG-HF and Medicare. We created two cohorts: those prescribed evidence-based beta blockers (BB) and/or renin-angiotensin system inhibitors (RASI) and those prescribed neither. We used overlap weighting to match the patient populations within age strata (65-74, 75-84 and 85+). We then used Cox proportional hazard models to determine the association between use at discharge and 30-day and 1-year mortality and readmissions. Results: The average HFrEF patient in this dataset was 79 (95% CI 72, 85) years old and 41% were female. Eighty percent were white. Ninety-seven percent (=47,299) received BB and/or RASI; 3% (n-1,412) received neither. The hazard ratio (HR) for BB and/or RASI vs. no BB or RASI for 1-year mortality or readmission among those aged 65-74 was HR=0.82 (95% CI 0.70-0.95); for those aged 75-84 HR=0.86 (95% CI 0.78-0.95) and for those aged 85+, the HR=0.78 (95% CI 0.71, 0.86). The p-value comparing HR across the age strata was 0.41. Similar results were observed for 30-day outcomes (Table 1) . Conclusions: The association between use of BB and/or RASI at hospital discharge and lower 30-day and 1-year mortality or readmission does not appear to vary across the age spectrum. Absent a contraindication, BB and/or RASI should be prescribed for all patients at discharge regardless of age.