Abstract 16214: Prescription of Teratogenic Medications for Reproductive-Age Women With Heart Failure With Reduced Ejection Fraction in a Safety-Net Health System

Abstract

Introduction: Angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), angiotensin receptor blocker-neprilysin inhibitors (ARNI), and mineralocorticoid receptor antagonists (MRA) have been proven to improve morbidity and mortality in patients with heart failure with reduced ejection fraction (HFrEF); however, they have known teratogenic effects. It is uncertain how often reproductive-age women are prescribed these medications and whether they are prescribed contraception. Methods: We included all patients in our health system with documented left ventricular ejection fraction ≤45% within the past 2 years. Patients were excluded from the present study if they had a creatinine ≥2.0 mg/dl (women) or ≥2.5 mg/dl (men), as these are contraindications to MRA. Individuals were stratified into reproductive-age women (age ≤45), women age >45, and men (any age). Contraception prescription was queried via chart review for all reproductive-age women. Rates of ACEi/ARB/ARNI, and MRA, were then compared across 4 subgroups. Results: Of 3,003 patients who met the inclusion criteria, 130 were women ≤45y, 709 were women > 45y, and 2164 were men. Among the 81/130 (62%) reproductive-aged women not prescribed contraception, 78% had an active prescription for either an ACEi, ARB, or ARNI and 56% had an active MRA prescription (Figure). Comparing reproductive-age women not on contraception with all other groups, the ACEi/ARB/ARNI prescription rates were 78% vs. 78% (p = 0.36) and the MRA prescription rates were 56% vs 49% (p = 0.16). Conclusions: In a large safety net health system, most reproductive-aged women with HFrEF, were not prescribed contraception, yet they were commonly prescribed teratogenic heart failure medications. This is an important safety concern that should be addressed at the health system level.