Abstract 11412: Use of Guideline-Directed Medical Therapies After Hospitalization for Heart Failure: Real-World Insights From EVOLUTION HF

Abstract

Introduction: In the period after hospitalization for heart failure (hHF), patients are at high risk of cardiovascular death and rehospitalization. Guidelines for heart failure with reduced ejection fraction (HFrEF) emphasize early initiation of four guideline-directed medical therapies (GDMTs: beta-blocker, renin-angiotensin system inhibitors [RASis] or angiotensin receptor neprilysin inhibitor, mineralocorticoid receptor antagonists, and sodium-glucose co-transporter-2 inhibitors [SGLT2is]). However, real-world data on the concurrent use of these four GDMTs are scarce, particularly after hHF. Methods: EVOLUTION HF is an observational, longitudinal cohort study using claims and electronic health record databases to assess the use of GDMTs in patients with a recorded hHF. We report KM estimates of initiation of GDMTs in the 3 months following an incident hHF (index date) with no prior HF diagnosis. Use of GDMTs in the month before the index hHF (e.g. RASis for hypertension) was counted as use at index. The study period started after approval of the first SGLT2i (dapagliflozin) for HFrEF in each country. Results: Overall, 49 807 patients were included. Ejection fraction was not recorded for most patients. Mean KM estimates for use of four GDMTs at 1 and 3 months post hHF discharge were 6.5% and 7.8% (Japan), 8.0% and 11.7% (Sweden), and 0.9% and 1.7% (USA), increasing with each consecutive calendar quarter (Figure). This trend was largely explained by an increase in SGLT2i use. In the first and last quarter of each study period, KM estimates of SGLT2i use at 3 months were 15.3% and 21.2% (Japan), 7.2% and 32.6% (Sweden), and 2.3% and 4.8% (USA). Conclusions: Uptake of four GDMTs remains low, highlighting an urgent need for earlier and increased GDMT initiation to manage severe risks, especially in the vulnerable post-hHF period. Data on SGLT2i benefits have led to a slow yet steady increase in SGLT2i early use post hHF as part of a four-GDMT approach to treating HF.