TRENDS IN GUIDELINE-DIRECTED MEDICAL THERAPY AMONG PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION
Author(s)
Xiaofan Liu, MPH1, Duy Hoang, PhD2, Rebecca A. Horn, PhD3, Hui Wang, PhD4, Mary Imboden, PhD5, Zheng Zeng, PhD6, Yang Yu, PhD7, Nina B. Masters, PhD2, Karen Gilbert Farrar, PhD2, Angela Lowe Winegar, PhD8, Brianna Cartwright, MS2, Ty J. Gluckman, MD5.
1University of Southern California, Los Angeles, CA, USA, 2Truveta, Bellevue, WA, USA, 3Edwards Lifesciences, Wichita, KS, USA, 4Lumbrita LLC, Saratoga, CA, USA, 5Providence, Portland, OR, USA, 6Lumbrita, San Francisco, CA, USA, 7Abbott, Santa Clara, CA, USA, 8Ascension, Austin, TX, USA.
1University of Southern California, Los Angeles, CA, USA, 2Truveta, Bellevue, WA, USA, 3Edwards Lifesciences, Wichita, KS, USA, 4Lumbrita LLC, Saratoga, CA, USA, 5Providence, Portland, OR, USA, 6Lumbrita, San Francisco, CA, USA, 7Abbott, Santa Clara, CA, USA, 8Ascension, Austin, TX, USA.
OBJECTIVES: This study assessed trends and timing of guideline-directed medical therapy (GDMT) initiation among patients with heart failure with reduced ejection fraction (HFrEF) and factors associated with rapid initiation.
METHODS: Retrospective cohort study using electronic health record (EHR) data from Truveta, a collective of US healthcare systems, to identify patients with a left ventricular ejection fraction (LVEF) of 10-40% in 2020-2024. The index date was the first qualifying LVEF. GDMT consisted of an evidence-based β‑blocker (carvedilol/metoprolol succinate/bisoprolol); ACE inhibitor, ARB, or ARNI; MRA; and SGLT2i. Rapid prescribing/dispensing was defined as prescribing/dispensing of all four medication classes within 30 days of the index date. Annual trends were tracked and multivariable logistic regression assessed factors associated with rapid initiation.
RESULTS: Among 243,709 adults, annualized prescribing and dispensing rates of all four classes rose from 9.9% and 2.5% in 2020 to 28.4% and 16.5% in 2024, respectively. Rapid prescribing and dispensing of all four classes also rose from 3.6% to 13.1% and 0.4% to 8.1%, respectively. Among individual classes, rapid prescribing and dispensing rates for a β‑blocker; ACE inhibitor, ARB, or ARNI; and MRA were largely unchanged over time, whereas prescribing and dispensing rates for an SGLT2i rose from 7.3% to 34.5% and 1.2% to 19.4%, respectively. Rapid dispensing occurred more often when the index LVEF was assessed during inpatient compared to outpatient settings (12.3% vs 3.2% in 2024). In adjusted analyses, rapid dispensing was more likely with rural residence (ORs 1.25; 95% CI 1.15-1.33) and obesity (1.73; 1.47-2.05) and less likely in those with a higher LVEF of 30%-40% (0.27; 0.25-0.29).
CONCLUSIONS: Prescribing and dispensing of GDMT in patients with HFrEF improved during 2020-2024 but remained underutilized. Similar findings were observed with rapid initiation of GDMT. Greater effort is needed to ensure timely initiation of these therapies.
METHODS: Retrospective cohort study using electronic health record (EHR) data from Truveta, a collective of US healthcare systems, to identify patients with a left ventricular ejection fraction (LVEF) of 10-40% in 2020-2024. The index date was the first qualifying LVEF. GDMT consisted of an evidence-based β‑blocker (carvedilol/metoprolol succinate/bisoprolol); ACE inhibitor, ARB, or ARNI; MRA; and SGLT2i. Rapid prescribing/dispensing was defined as prescribing/dispensing of all four medication classes within 30 days of the index date. Annual trends were tracked and multivariable logistic regression assessed factors associated with rapid initiation.
RESULTS: Among 243,709 adults, annualized prescribing and dispensing rates of all four classes rose from 9.9% and 2.5% in 2020 to 28.4% and 16.5% in 2024, respectively. Rapid prescribing and dispensing of all four classes also rose from 3.6% to 13.1% and 0.4% to 8.1%, respectively. Among individual classes, rapid prescribing and dispensing rates for a β‑blocker; ACE inhibitor, ARB, or ARNI; and MRA were largely unchanged over time, whereas prescribing and dispensing rates for an SGLT2i rose from 7.3% to 34.5% and 1.2% to 19.4%, respectively. Rapid dispensing occurred more often when the index LVEF was assessed during inpatient compared to outpatient settings (12.3% vs 3.2% in 2024). In adjusted analyses, rapid dispensing was more likely with rural residence (ORs 1.25; 95% CI 1.15-1.33) and obesity (1.73; 1.47-2.05) and less likely in those with a higher LVEF of 30%-40% (0.27; 0.25-0.29).
CONCLUSIONS: Prescribing and dispensing of GDMT in patients with HFrEF improved during 2020-2024 but remained underutilized. Similar findings were observed with rapid initiation of GDMT. Greater effort is needed to ensure timely initiation of these therapies.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EPH4
Topic
Epidemiology & Public Health
Topic Subcategory
Public Health
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory)