Abstract 14740: Identifying Predictors of Timing to Guideline-Directed Medical Therapy for Medical Beneficiaries With Heart Failure

Abstract

Introduction: Despite substantial evidence supporting the timely initiation and optimization of guideline-directed medical therapy (GDMT) for patients with heart failure, its utilization remains low. Hypothesis: Variation in GDMT prescribing will be explained by patient-, clinician-, and hospital-level determinants that can serve as targets for future interventions. Methods: This study included 793,319 fee-for-service Medicare beneficiaries admitted with heart failure (incident or acute-on-chronic) between 2009-17. The GDMT outcome was the receipt of 1 from each of 3 medication classes within 120 days of discharge: beta blockers, ACE inhibitors/ARBs, or MRAs. Candidate predictors included patient demographics, pre-admission medication, community distress (social determinants), and Charlson comorbidities. Models, estimated via logistic regression and marginal effects, considered unobserved changes in practice patterns over time and, in some specifications, provider differences (fixed effects). Other specifications controlled for observed hospital characteristics. Results: The cohort was 49% female (n=390,765), 16% Black (n=123,238), 6% Hispanic (n=50,138) with a median (IQR) of 78 years (69-86). The median number of comorbidities was 3 (IQR 2-4). The overall 120-day use of beta blockers was 55%, ACE inhibitors/ARBs 47%, MRAs 21%, and all three medications 11%. After adjustment, the largest predictors of GDMT were pre-admission medication use and comorbidities (eg, renal disease). Women achieved 0.9% lower GDMT (Figure). Community distress was associated with lower GDMT; yet, the magnitude of effect was small (-0.01%). Academic hospitals achieved 0.3% better GDMT despite having a more severe patient population. Conclusions: GDMT use was low (and lowest for MRAs). Targeted interventions to address these identified predictors may advance the prescribing and use of guideline-directed, evidence-based care for heart failure patients.