Abstract 14525: Mapping Disparities in Use of Guideline-Directed Medical Therapies for Heart Failure Patients With Reduced Ejection Fraction

Abstract

Introduction: Current guidelines recommend simultaneous or rapid sequence initiation of multidrug guideline-directed medical therapy (GDMT) classes for heart failure with reduced ejection fraction (HFrEF). Despite this, well documented gaps in implementation exist; however, little is known regarding geographic disparities at the county level. Methods: A cohort study was conducted using Medicare claims (2013-2019). Patients from the study cohort were assigned to counties based on their residential ZIP codes. County level triple therapy use- defined as simultaneous prescription fills for beta blockers, renin-angiotensin system inhibitors (RASi), and mineralocorticoid receptor antagonists (MRAs), within 90 days of a medical encounter where HF was recorded- were calculated as %s. Features of counties including area-level indicators of poverty, employment, and educational attainment and aggregated patient-level sociodemographic and medical history variables were compared by quintiles of triple therapy use. Results: 304,857 patients from 2,600 counties were included. The median (interquartile range [IQR]) for three drug therapy use was 14.3% (10.3%-18.8%) across included counties with a wide variation (range: 0% to 54.5%). Counties in the lowest quintile of triple therapy use were concentrated in the South. Compared to counties in the highest use quintile, counties in lowest triple therapy use quintile had worse area-level indicators of socioeconomic status and were more frequently rural. Among patient-level sociodemographic factors, counties in lowest quintile had higher proportion of Blacks and patients with low-income subsidy. Conclusion and Relevance: Simultaneous use of three GDMT classes was infrequent in patients with HFrEF and a marked variation across counties was observed correlating with indicators of socioeconomic disadvantage. Addressing implementation gaps in GDMT use is a pressing need that requires urgent attention.