Abstract 17432: Utilization of Heart Failure Therapies: Assessing Trends and Adoption of Updated Guideline Directed Medical Therapy Following the 2022 Heart Failure Guideline Release

Abstract

Introduction: The adoption rate of new guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) is unclear. Thus, we assessed temporal trends in GDMT prescription following the release of the 2022 ACC/AHA heart failure guidelines. Methods: Using the TriNetX database, we identified HFrEF patients with an EF = 40%. Seven 2-month time windows between April 1, 2022 and May 31, 2023 were analyzed. Treatment categories included sacubitril (proxy variable for angiotensin receptor/neprilysin inhibitor), angiotensin-converting enzyme inhibitors (ACEi), beta blockers, mineralocorticoid-receptor antagonists, sodium glucose transport 2 inhibitors (SGLT2i), isosorbide dinitrate, ivabradine, hydralazine, and ICD/CRT. Incidence rate and prevalence of GDMT prescription were assessed over 14 months post-guideline publication. Results: Analysis included 167,740 HFrEF patients. Sacubitril prevalence doubled between 2022 (18.326%) and 2023 (36.779%), with a higher rate of increase after January 2023. ARB prescription prevalence increased from 39.031% to 58.696%, with notable incidence growth after January 2023. Prevalence of SGLT2i prescription increased from 14.794% in 2022 to 34.14% in 2023. Incidence rates for other therapies also showed upward trends, resulting in increased overall therapy prevalence. Slightly lower 1-month hospitalization (46.378% vs 46.654%) and mortality (7.327% vs 7.549%) were observed in the 14 months after guideline publication compared to the 14 months prior. Conclusions: Improved adherence to GDMT guidelines has occurred since the release of the 2022 guidelines. Notably, utilization of ARNIs and SGLT2 inhibitors significantly increased. However, prescription rates for these novel therapies were below 50%, highlighting the need to expand access to a larger proportion of HFrEF patients.