Impact of socio-demographic and ethnic determinants in guideline-directed medical therapy implementation during heart failure hospitalization

Aims To assess for the first time the impact of socio-demographic variables on prescription of guideline-directed medical therapy (GDMT) after an episode of heart failure (HF) decompensation in the Italian healthcare system. Methods and results Utilizing ‘GENERATOR-HF DataMart’, a cross-sectional analysis was performed. We included patients with HF and reduced ejection fraction discharged between January 2019 and July 2024. The degree of GDMT implementation across the different socio-demographic variables (i.e. patient's age, sex, marital status, nationality, place of residence, and educational level) was evaluated through the modified optimal medical therapy (mOMT) score (i.e. a ratio between the number of pillars actually prescribed and the number of pillars that could be prescribed on the basis of each specific contraindication). A multivariable logistic regression model was also fitted to assess the association between the socio-demographic variables and the prescription of each pillar and loop diuretics. 1730 patients (median age: 72 years; 24% females) were included. The mOMT score was significantly lower in elderly patients, but comparable across other pre-specified socio-demographic categories. In multivariable regression analysis, older age was the only independent socio-demographic predictor of under-prescription both overall and for ACEi/ARB/ARNI (OR0.70; 95% CI 0.55–0.89), beta-blockers (OR0.59; 95% CI 0.41–0.84) and SGLT2i (OR0.66, 95% CI 0.47–0.93), while also associated with a loop diuretics use (OR1.56; 95% CI 1.13–2.17). A higher mOMT score was significantly associated with a reduced incidence of early adverse events (i.e. 30-day all-cause death and urgent re-admissions) (4.1% vs. 8.5%; P = 0.001). Conclusion Older age was the only independent predictor of under-prescription of GDMT and enhanced use of loop diuretics, whereas no discrepancies were found across the other socio-demographic subgroups.