Abstract P386: Pre-hospitalization Medication Use in Black and White Medicare Beneficiaries Hospitalized With Heart Failure

Abstract

Background: Guidelines for treatment of heart failure (HF) with reduced ejection fraction recommend use of β-blockers, angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), aldosterone antagonists, diuretics, digoxin, and, for blacks, the combination of hydralazine and isosorbide dinitrate. Race-specific treatment guidelines, differences in pathophysiology, comorbidities, and contraindications, and patient and provider preferences may result in differential use of these medications in blacks and whites with HF. Objectives: To examine differences in pre-hospitalization medication use among black and white Medicare beneficiaries hospitalized for HF. Methods: Medicare beneficiaries with fee-for-service and pharmacy coverage who had HF hospitalizations (inpatient claims for ≥1 overnight stay with HF as the primary discharge diagnosis, discharged alive) between 2007 and 2011 were identified in the Medicare national 5% sample. More than 98% of Medicare beneficiaries hospitalized for HF had prior inpatient or outpatient diagnoses of HF. Characteristics and medication use in the year prior to hospitalization were assessed through Medicare data. We compared pre-hospitalization medication use between black and white beneficiaries in the overall population with HF (n = 42,721) and in the subpopulation with documented systolic dysfunction (n = 9,702) with a χ 2 test. Results: Use of β-blockers and aldosterone antagonist was similar between blacks and whites ( Table ). Blacks were more likely to use ACE inhibitors, ARBs, and hydralazine. Whites were more likely to use diuretics and digoxin. Results were consistent when the population was limited to those with documented systolic dysfunction. Conclusions: Blacks were as likely as or more likely than whites to receive pharmacologic heart failure therapies with the exception of diuretics, which were none the less commonly used, and digoxin. Additional research is needed to determine the causes and implications of these differences.