Abstract 10646: The Use of Beta Blockers and Renin Angiotensin System Inhibitors Among Patients with Concurrent HFrEF and Alzheimer’s Disease and Related Dementias (ADRD)

Abstract

Introduction: Recent data suggests that patients with concurrent HFrEF and ADRD (HF+ADRD) have markedly higher mortality than HFrEF patients without ADRD. One of the proposed mechanisms for this is a lower rate of guideline directed medical therapy (GDMT) use in the HF+ADRD population. The aim of this study is to determine the change in GDMT use before and after HFrEF hospitalization for patients with HF+ADRD. Methods: We used 100% Medicare Parts A and B and a random 40% sample of Part D to create a cohort of 397,680 fee-for-service beneficiaries with ≥1 hospitalization for HFrEF between 2012 and 2018. We used previously validated ICD-9/10 codes to define ADRD. We created 4 exposure groups for both evidenced-based beta-blockers (BB) and renin angiotensin system inhibitors (RASI): “continued” (on drug before and after hospitalization); “initiated” (not on before, but on after); “discontinued” (on before, but not after) and “never started” (not on before or after). Results: Rates of BB continuation (42% vs. 37%, p<0.001) and initiation (24% vs. 18%, p<0.001) were higher among HFrEF patients without ADRD ( Table 1 ). Rates of BB discontinuation (13% vs. 10%, p<0.001) and never starting (32% vs. 24%, p<0.001) were higher among HF+ADRD patients. Similarly, rates of RASI continuation (33% vs. 26%, p<0.001) and initiation (18% vs. 15%, p<0.001) were higher among HFrEF patients without ADRD. Rates of RASI discontinuation (15% vs. 14%, p<0.001) and never starting (44% vs. 35%, p<0.001) were higher among HF+ADRD patients. Conclusions: Rates of BB/RASI continuation and initiation are higher among HFrEF patients without ADRD while rates of BB/RASI discontinuation and never starting are higher among HF+ADRD patients. Additional work is needed to understand why GDMT use is lower in patients with HF+ADRD and to determine whether, in this population, there are adverse outcomes associated with failing to receive GDMT, such as increased HFrEF symptoms, hospital admissions, and mortality.