Association between Socioeconomic Factors and Guideline-Directed Medical Therapy (GDMT) Utilization Among Medicare Beneficiaries with Heart Failure with Reduced Ejection Fraction (HFrEF)
Author(s)
Nabin Poudel, PhD1, Sandeep Devabhakthuni, PharmD, BCCP2, Catherine Cooke, PharmD, BCPS, PAHM1, Chitra Mistry, BPharm1, Adria Pirozzi, B.S1, Gautam Ramani, MD1, Abree Johnson, MS/MBA1, Onyemauchechukwu Ijezie, B.S1, Julia F. Slejko, PhD1;
1University of Maryland Baltimore, Baltimore, MD, USA, 2U.S. Food and Drug Administration, Silver Spring, MD, USA
1University of Maryland Baltimore, Baltimore, MD, USA, 2U.S. Food and Drug Administration, Silver Spring, MD, USA
OBJECTIVES: To examine the association between socioeconomic factors and guideline-directed medical therapy (GDMT) utilization among Medicare beneficiaries with heart failure with reduced ejection fraction (HFrEF).
METHODS: We conducted a retrospective cohort study using Chronic Condition Data Warehouse data (2016-2021) to identify Medicare beneficiaries aged ≥66 years on Index date, with at least two diagnoses for HFrEF within 12 months on different dates. The use of GDMT overall and by class (i.e., angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor neprilysin inhibitors (ACE/ARBs/ARNIs), beta blockers (BB), mineralocorticoid receptor antagonists (MRA), and sodium-glucose co-transporter-2 inhibitors (SGLT2i) was assessed at baseline and post-index. We descriptively analyzed sociodemographic characteristics at baseline, including age, gender, race, census region, Charlson Comorbidity Index (CCI), and dual eligibility. We then used multivariable logistic regression (MLR) to evaluate associations between sociodemographic factors and GDMT utilization.
RESULTS: Among 237,100 beneficiaries with HFrEF, mean age was 77 years, with 51% female and 69% non-dual eligible. MLR showed females had lower odds of using ACE/ARB/ARNI [odds ratio (OR)=0.929, 95% confidence interval (CI)=0.912-0.947], BB [OR=0.786, CI=0.771-0.8], and SGLT2i [OR=0.708, CI=0.677-0.741] versus males. Dual eligible beneficiaries had lower odds of using ACE/ARB/ARNI [OR=0.907, CI=0.886-0.928], BB [OR=0.766, CI=0.75-0.784], and MRA [OR=0.795, CI=0.775-0.815] versus non-dual eligible. Black beneficiaries were more likely to use BB [OR=1.244, CI=1.204-1.285] but less likely to use MRA [OR=0.892, CI=0.862-0.924] and SGLT2i [OR=0.8, CI=0.742-0.862] versus White. Beneficiaries with lower CCI (1-2) had higher odds of using ACE/ARB/ARNI [OR=1.347, CI=1.312-1.382], BB [OR=1.14, CI=1.112-1.169], MRA [OR=1.341, CI=1.306-1.377] and lower odds of using SGLT2i [OR=0.493, CI=0.459-0.53] compared to those with higher CCI (>=5). GDMT use varied by age and region.
CONCLUSIONS: Sociodemographic factors such as age, gender, race, census region, CCI comorbidity burden, and dual eligibility significantly impact GDMT utilization. These findings underscore the need to address sociodemographic barriers when designing interventions to improve equitable access to medication.
METHODS: We conducted a retrospective cohort study using Chronic Condition Data Warehouse data (2016-2021) to identify Medicare beneficiaries aged ≥66 years on Index date, with at least two diagnoses for HFrEF within 12 months on different dates. The use of GDMT overall and by class (i.e., angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor neprilysin inhibitors (ACE/ARBs/ARNIs), beta blockers (BB), mineralocorticoid receptor antagonists (MRA), and sodium-glucose co-transporter-2 inhibitors (SGLT2i) was assessed at baseline and post-index. We descriptively analyzed sociodemographic characteristics at baseline, including age, gender, race, census region, Charlson Comorbidity Index (CCI), and dual eligibility. We then used multivariable logistic regression (MLR) to evaluate associations between sociodemographic factors and GDMT utilization.
RESULTS: Among 237,100 beneficiaries with HFrEF, mean age was 77 years, with 51% female and 69% non-dual eligible. MLR showed females had lower odds of using ACE/ARB/ARNI [odds ratio (OR)=0.929, 95% confidence interval (CI)=0.912-0.947], BB [OR=0.786, CI=0.771-0.8], and SGLT2i [OR=0.708, CI=0.677-0.741] versus males. Dual eligible beneficiaries had lower odds of using ACE/ARB/ARNI [OR=0.907, CI=0.886-0.928], BB [OR=0.766, CI=0.75-0.784], and MRA [OR=0.795, CI=0.775-0.815] versus non-dual eligible. Black beneficiaries were more likely to use BB [OR=1.244, CI=1.204-1.285] but less likely to use MRA [OR=0.892, CI=0.862-0.924] and SGLT2i [OR=0.8, CI=0.742-0.862] versus White. Beneficiaries with lower CCI (1-2) had higher odds of using ACE/ARB/ARNI [OR=1.347, CI=1.312-1.382], BB [OR=1.14, CI=1.112-1.169], MRA [OR=1.341, CI=1.306-1.377] and lower odds of using SGLT2i [OR=0.493, CI=0.459-0.53] compared to those with higher CCI (>=5). GDMT use varied by age and region.
CONCLUSIONS: Sociodemographic factors such as age, gender, race, census region, CCI comorbidity burden, and dual eligibility significantly impact GDMT utilization. These findings underscore the need to address sociodemographic barriers when designing interventions to improve equitable access to medication.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
HPR21
Topic
Health Policy & Regulatory
Topic Subcategory
Health Disparities & Equity
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)