Abstract 12492: Relation of Medical and Social Determinants of Health to Use of Guideline-Directed Medical Therapy for Heart Failure With Reduced Ejection Fraction in the All of Us Research Program

Abstract

Background: HFrEF is associated with significant morbidity and mortality. The standard of care is guideline-directed medical therapy (GDMT) consisting of evidence-based pharmacological interventions which have demonstrated improved outcomes in HFrEF. However, paltry adherence to GDMT remains an ongoing challenge. We examined in US adults the relationship between social determinants of health (SDOH), demographics, and risk factors on GDMT adherence for HFrEF. Methods: The NIH All of Us Research Program started in May 2018 with the goal of enrolling over 1 million US residents. Over 315,000 participants have shared electronic health records, physical measurements, surveys, and lab results. Demographics, risk factors, and SDOH measures were captured for HFrEF in US adults 18 years or older. Patients with HFrEF who were on quadruple therapy (ACE-inhibitor/angiotensin receptor/combination angiotensin receptor-neprilysin inhibitor, beta-blocker, SGLT2 inhibitor, mineralocorticoid antagonist) were compared to those on fewer. Multiple logistic regression analyses were conducted to examine the association between risk factors/SDOH measures and medical therapy optimization. Results: In the All of Us data, 6049 patients were identified with HFrEF. Of those patients, 5838 (97%) patients were on less than 4 GDMT, while 210 (3%) patients were on quadruple therapy. Multiple logistics regression showed participants with ASCVD, and diabetes had higher odds (95% CI) of being on quadruple therapy, 2.19 [1.28, 3.99] and 9.07 [4.88, 18.84], respectively, while hypertension had lower odds (0.64 [0.43, 0.95]). Race, income, education, and health insurance types did not predict medical therapy optimization. Conclusion: Various cardiovascular conditions were associated with higher odds of being on quadruple therapy. However, sociodemographic factors did not show a correlation of predicting the odds of achieving maximal medical therapy.