Abstract 18125: Disparities in HFrEF Patients Excluded From Guideline Directed Medical Therapy at an NYC Safety Net Hospital

Abstract

Introduction: Prescription of GDMT in heart failure with HFrEF patients is an important performance measure. However, little has been explored into the populations that are purposely excluded from the prescription of GDMT because of medical contraindications, patient refusal, cost, etc. We explored the disparities for the non-prescription of GDMT at an NYC hospital. This is essential to understand the gaps in the treatment of HFrEF patients. Hypothesis: No clinical or demographic disparities exist in the exclusion of patients from the prescription of GDMT. Methods: Data were collected retrospectively through the Get With The Guidelines™- Heart Failure registry for HFrEF (LVEF =<40%) patients admitted at NYC Health+Hospital/Jacobi Medical Center from 1/1/2017-5/31/2022. Only records without missing data for each medication class were included, resulting in 869 records for ACEI/ARB/ARNI, 373 for SGLT2i, 830 for beta-blocker, and 865 for MRA. Logistic regression including both demographic and clinical factors was used to analyze the exclusion outcome from each GDMT. Results were presented as adjusted odds ratios at 0.05 level of significance. Results: 50.29% had documented exclusion (e.g. contraindication, patient refusal, etc.) from the prescription of ACEI/ARB/ARNI, 46.65% from SGLT2i, 7.5% from beta-blockers, 42% from MRAs. Of these patients, 56.85%, 48.39%, 53.33% and 41.76% of patients had a “patient reason” for not being prescribed ACEI/ARB/ARNI, beta-blockers, SGLT2i, and MRAs at discharge, respectively. Results are summarized in the Table. Conclusions: Both clinical and demographic factors had significant associations with the nonprescription of GDMT. There is a sizable population of patients with non-medical reasons for nonprescription of GDMT. A more granular analysis of patient-related reasons (such as cost, patient education, etc.) should be explored to improve the prognosis of this vulnerable population with HFrEF.