Abstract 14848: Interplay of Cardiovascular Risk Factors, Comorbidities, Demographics, and Social Determinants of Health on Adherence to Guideline Directed Medical Therapies in Heart Failure With Preserved Ejection Fraction: The All of Us Research Program

Abstract

Background: Despite its high prevalence, HFpEF is difficult to diagnose and treat due to its complex pathophysiology. Unlike HFrEF, treatments are limited for HFpEF. A combination of SGLT2i, angiotensin receptor neprilysin inhibitor (ARNi), and mineralocorticoid antagonist (MRA) has been shown to improve cardiovascular outcomes; however, acceptance of GDMT remains an obstacle in clinical practice. We sought to investigate the relationship of social determinants of health (SDOH), demographics, comorbidities, and risk factors with prescription patterns to GDMT for HFpEF. Methods: The All of Us Research Program, which began in May 2018, is a diverse database that prioritizes historically marginalized populations. Demographics, risk factors, and SDOH measurements were compared with use of GDMT for HFpEF adults aged 18 years and over. Multiple logistic regression analysis was used to examine the association among demographics, comorbidities, risk factors and SDOH with use of at least two of the recommended GDMT therapies for HFpEF (SGLT2 inhibitor, angiotensin receptor/ARNi, and MRA). Result: The study found that 38.4% (3773) of the 9823 adults with chronic heart failure had HFpEF. 51% of those with HFpEF do not take any GDMT, 11% take 2/3 of the GDMT, and only 1% take all three. Furthermore, a multiple logistic regression analysis revealed a greater odds of being on at least 2 GDMT for HFpEF among participants with known ASCVD (1.96 [1.41, 2.78]), diabetes (2.15 [1.56, 3.01]), and BMI ≥ 35 kg/m2 (1.02 [1.01, 1.04]). In addition, female sex is also associated with increased odds of being on at least two agents (1.46 [1.08, 2.00]). The likelihood of being prescribed GDMT for HFpEF was not predicted by race, education, income, or health insurance type. Conclusion: Risk factors such as ASCVD, diabetes and obesity were shown to be associated with an increased rate of GDMT use, while sex differences are also present.