Abstract 16433: Quality Initiative Tied to Physician Reimbursement Significantly Improves Sacubitril/valsartan and Spironolactone Use Among Patients With Heart Failure With Reduced Ejection Fraction

Abstract

Introduction: Despite data showing reductions in risk of death and heart failure hospitalization in heart failure patients with reduced ejection fraction (HFrEF), sacubitril/valsartan (SV) and mineralocorticoid-receptor antagonist (MRA) adoption rates have remained low. We hypothesized that instituting a quality initiative (QI) that prospectively identified SV/MRA candidacy in HFrEF patients and tied successful use of MRA/SV in eligible patients to total health system compensation would improve utilization rates. Methods: A HFrEF QI was implemented whereby a portion of a large outpatient cardiology practice’s total compensation by the health system was tied to successful SV and MRA use in HFrEF patients (EF<40%) with NYHA class II-IV symptoms. Quality metric goals that triggered maximum reimbursement were set at >25% SV use and >60% MRA use in eligible HFrEF patients, given the low rates of appropriate SV and MRA use nationally. Following QI introduction, patients with the above eligibility criteria were prospectively identified over one year. Providers were sent daily e-mails notifying them of eligible patients that day, and during the patient visit were prompted to complete a form, documenting use of SV, MRA, and/or any contraindications to their use including blood pressure, renal function, potassium level, ACE/ARB intolerance, or financial obstacles. To serve as a control arm, data was retrospectively collected on 6 months of consecutive HFrEF patients with the same eligibility criteria prior to QI initiation. Results: Of 1345 retrospectively identified HFrEF patients prior to initiating the QI, 855 (63.5%) and 964 (71.7%) met SV and MRA eligibility criteria. Of these, 324 (37.9%) were prescribed SV, 365 (37.9%) an MRA. Following QI implementation, 3792 patients with HFrEF were prospectively identified, and of these 2550 (67.2%) and 2589 (68.2%) met eligibility criteria for SV and MRA initiation. SV use in eligible patients increased from 37.9% pre-QI, to 72.1% post-QI (p < 0.001). MRA use increased from 37.9% pre-QI to 66.2% post-QI (p < 0.001). Conclusions: A quality initiative linking successful implementation of SV and MRA use in eligible HFrEF patients to physician compensation resulted in a significant increase in SV and MRA adoption rates.