Abstract 12786: Contemporary Outpatient Management of Patients With and Without Worsening Heart Failure With Reduced Ejection Fraction Within A Single Integrated System: Results From Electronic Medical Record Data in the CHART-HF Study

Abstract

Background: Patients with HFrEF and worsening HF events (WHFE) have substantial disease burden and poor outcomes. CHART-HF aims to characterize real-world clinical characteristics, longitudinal treatment use, and therapeutic decision-making among patients with HFrEF with vs without WHFE. Methods: Retrospective analysis of EMR data of 1000 adult patients with HF (with LVEF <45%) from a single integrated health system with 2 mutually exclusive cohorts was conducted. The WHFE cohort included patients with a WHFE (i.e., hospitalization or receipt of IV diuretics) between 2017-2019 followed by an index outpatient cardiology visit ≤6 months. The control cohort included patients with no WHFE in a given year between 2017-2019. Index visit was defined as the last outpatient cardiology visit in the given year. Treatment use followed for 12 months. Results: Patients with WHFE were slightly older (68.6 vs. 68.0 years), had more females (28.8 vs. 24.4%) and had more comorbidities such as hypertension, atrial fibrillation, COPD, diabetes mellitus and chronic kidney disease compared with control patients (p>0.05). On index date, 81% of WHFE cohort patients were on beta blocker (BB), 55% on ACEI/ARB/ARNI, and 18% on MRA ( Figure, Panel A ) while 75%, 66%, and 22%, respectively, in the control cohort ( Figure, Panel B ). In both the WHFE and control cohorts, use of BB and ACEI/ARB/ARNI decreased while patients without any GDMT increased in the 12 months. The most frequent reason for not changing GDMT was “clinically stable and/or adequate symptom control” ( Figure, Panel C ). The median time to next HF hospitalization or death was 30 and 136 weeks from index date in WHFE and control cohort, respectively (p<0.001). Conclusion: Among US patients with HFrEF, there remain major gaps in use of GDMT and these gaps persist during longitudinal outpatient follow-up. These longitudinal gaps in GDMT are particularly large among the high-risk subset of patients with a recent WHFE.