Key result
Underinsurance and adverse social determinants link to lower rates of GDMT optimization in heart failure.
Why the study?
Fewer than 20% of eligible patients with HFrEF receive all 4 pillars of guideline-directed medical therapy, and disparities by race, ethnicity, sex, and social determinants of health are not well understood.
Observational (n=82,637)
Yes
Answers are grounded in this paper and cite their sources.
Adverse social determinants of health, particularly lack of insurance and documented social needs, are associated with significantly lower optimization of guideline-directed medical therapy in patients hospitalized for HFrEF.
BACKGROUND: Fewer than 20% of eligible patients with heart failure with reduced ejection fraction receive all 4 pillars of guideline-directed medical therapy. Understanding disparities by race, ethnicity, sex, and adverse social determinants of health is necessary to equitably optimize quadruple therapy. METHODS: Utilizing the American Heart Association's Get With The Guidelines-Heart Failure registry, we examined associations between race and ethnicity, sex, and adverse social determinants of health (insurance type and documented social need [any barrier to accessing health care]) with quadruple therapy optimization (QTO) in patients with heart failure with reduced ejection fraction hospitalized between July 1, 2021, and September 30, 2023, with complete medication data at discharge. We calculated adjusted mean differences (AMDs) in the discharge QTO score (range, 0%-100%) reflecting the proportion of eligible use of renin-angiotensin system inhibitors, β-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors and compared across demographic and adverse social determinants of health groups. RESULTS: Among 82 637 patients (median age, 66 years; 32.5% female; 57.0% non-Hispanic White; 76.4% prior heart failure with reduced ejection fraction), the overall mean QTO score was 56.2% (SD, 25.5). After adjustment, compared with non-Hispanic White individuals, Black (AMD, 2.56 percentage points [95% CI, 2.16-2.96]) and Hispanic individuals (AMD, 0.71 percentage points [95% CI, 0.11-1.31]) had higher QTO scores. Females had higher QTO scores than males (AMD, 1.94 percentage points [95% CI, 1.58-2.31]). Patients with no insurance (AMD, -4.90 percentage points [-5.62 to -4.17]), Medicaid (AMD, -0.45 percentage points [-0.89 to -0.01]), and Medicare (AMD, -1.64 percentage points [-2.10 to -1.18]) had lower QTO scores versus private insurance. Those with an identified social need (n=24 651) had lower QTO scores than those without (AMD, -3.40 percentage points [95% CI, -4.10 to -2.71]). CONCLUSIONS: Disparities in QTO were most evident for patients with no insurance, Medicaid, Medicare, or potentially an identified social need. Future efforts should focus on reducing gaps to improve equitable guideline-directed medical therapy use.
No takes yet. Share an insight, caveat, or question.
Jacobs et al. (2024) conducted an observational in Heart failure with reduced ejection fraction (n=82,637). Adverse social determinants of health (insurance type and social need) vs. Private insurance and no documented social need was evaluated on Discharge quadruple therapy optimization (QTO) score (AMD -3.40, 95% CI -4.10 to -2.71). Adverse social determinants, including no insurance and identified social needs, were associated with lower quadruple therapy optimization scores at discharge.
Synapse has enriched 10 related papers. Consider them for comparative context: