Heath Care Use Before Incident HF Hospitalization: Women Are More Vulnerable And Less Investigated Than Men
HFSA ePoster Library. Anderson K. 09/10/21; 343658; 98
Kim Anderson
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Abstract
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Introduction: Guideline-directed medical therapy (GDMT) is an important aspect of care for HFrEF patients, with benefits seen through improved outcomes and increased overall survival. Care for HFrEF patients on GDMT involves accounting for the racial profile of each individual patient. The objective of this study was to evaluate whether black patients with HFrEF were being prescribed medications based on GDMT at the same rate as non-black patients.
Methods: This was a cross-sectional study of prescribing trends for HFrEF patients in Michigan Medicine’s Heart Failure Registry. Medication class (angiotensin-converting enzyme inhibitors [ACEi]/angiotensin II receptor blockers [ARB]/ angiotensin receptor neprilysin inhibitors [ARNI], beta-blockers, mineralocorticoid receptor antagonists [MRA]), sex, race, serum creatinine, potassium, systolic blood pressure, and heart rate were documented for each patient. First, stepwise logistic regression was used to determine the predictors of GDMT prescribing. Next, blacks and non-blacks were propensity matched based on those predictors of GDMT prescribing to determine the potential difference in prescribing by race.
Results: The two significant predictors for ACEi/ARB/ARNIs were serum creatinine and potassium levels (n = 1556; OR 1.55 [1.37, 1.75], p < 0.0001; OR 0.67 [0.56, 0.89], p=0.0056). For beta-blockers the lone predictor was heart rate (n = 2083,OR: 1.02 [1.01, 1.03]; p=0.0001), while for MRAs the predictors were race (black vs non-black), and serum creatinine level (n = 2380, OR: 1.34 [1.06, 1.70]; p= 0.014; OR: 0.54 [0.46, 0.64]; p < 0.0001). The results of the stepwise regression provided the variables on which we were able to successfully match black and non-black patients via optimal fixed ratio matching. Overall, there were 269 black patients matched to 269 non-black patients with similar propensity scores (mean difference = 0.00003, 99.9% reduction). These propensity scores were determined from the most recent systolic blood pressure, heart rate, serum creatinine and potassium level. After matching, it was determined that blacks had a higher prescription rate of ACEi/ARB/ARNI compared to non-black patients (77.70% vs 69.52%; OR 1.53 [1.04, 2.25]; p=0.03). For beta-blockers and MRAs, there were no significant differences between blacks and non-blacks. Beta-blockers were prescribed in 85.9% of black patients vs 85.1% of non-black patients (OR 1.06 [0.66, 1.72]; p=0.81), and MRAs were prescribed in 52.8% of black patients vs 47.2% of non-black patients (OR 1.25 [0.89, 1.75]; p=0.20).
Conclusion: Prescribing rates did not differ based on whether the patient self-identified as black or non-black at an academic medical center. After matching based on predictors of GDMT prescribing, black patients were more likely to be treated with an ACEi/ARB/ARNI’s when compared to non-black patients.
Methods: This was a cross-sectional study of prescribing trends for HFrEF patients in Michigan Medicine’s Heart Failure Registry. Medication class (angiotensin-converting enzyme inhibitors [ACEi]/angiotensin II receptor blockers [ARB]/ angiotensin receptor neprilysin inhibitors [ARNI], beta-blockers, mineralocorticoid receptor antagonists [MRA]), sex, race, serum creatinine, potassium, systolic blood pressure, and heart rate were documented for each patient. First, stepwise logistic regression was used to determine the predictors of GDMT prescribing. Next, blacks and non-blacks were propensity matched based on those predictors of GDMT prescribing to determine the potential difference in prescribing by race.
Results: The two significant predictors for ACEi/ARB/ARNIs were serum creatinine and potassium levels (n = 1556; OR 1.55 [1.37, 1.75], p < 0.0001; OR 0.67 [0.56, 0.89], p=0.0056). For beta-blockers the lone predictor was heart rate (n = 2083,OR: 1.02 [1.01, 1.03]; p=0.0001), while for MRAs the predictors were race (black vs non-black), and serum creatinine level (n = 2380, OR: 1.34 [1.06, 1.70]; p= 0.014; OR: 0.54 [0.46, 0.64]; p < 0.0001). The results of the stepwise regression provided the variables on which we were able to successfully match black and non-black patients via optimal fixed ratio matching. Overall, there were 269 black patients matched to 269 non-black patients with similar propensity scores (mean difference = 0.00003, 99.9% reduction). These propensity scores were determined from the most recent systolic blood pressure, heart rate, serum creatinine and potassium level. After matching, it was determined that blacks had a higher prescription rate of ACEi/ARB/ARNI compared to non-black patients (77.70% vs 69.52%; OR 1.53 [1.04, 2.25]; p=0.03). For beta-blockers and MRAs, there were no significant differences between blacks and non-blacks. Beta-blockers were prescribed in 85.9% of black patients vs 85.1% of non-black patients (OR 1.06 [0.66, 1.72]; p=0.81), and MRAs were prescribed in 52.8% of black patients vs 47.2% of non-black patients (OR 1.25 [0.89, 1.75]; p=0.20).
Conclusion: Prescribing rates did not differ based on whether the patient self-identified as black or non-black at an academic medical center. After matching based on predictors of GDMT prescribing, black patients were more likely to be treated with an ACEi/ARB/ARNI’s when compared to non-black patients.
Introduction: Guideline-directed medical therapy (GDMT) is an important aspect of care for HFrEF patients, with benefits seen through improved outcomes and increased overall survival. Care for HFrEF patients on GDMT involves accounting for the racial profile of each individual patient. The objective of this study was to evaluate whether black patients with HFrEF were being prescribed medications based on GDMT at the same rate as non-black patients.
Methods: This was a cross-sectional study of prescribing trends for HFrEF patients in Michigan Medicine’s Heart Failure Registry. Medication class (angiotensin-converting enzyme inhibitors [ACEi]/angiotensin II receptor blockers [ARB]/ angiotensin receptor neprilysin inhibitors [ARNI], beta-blockers, mineralocorticoid receptor antagonists [MRA]), sex, race, serum creatinine, potassium, systolic blood pressure, and heart rate were documented for each patient. First, stepwise logistic regression was used to determine the predictors of GDMT prescribing. Next, blacks and non-blacks were propensity matched based on those predictors of GDMT prescribing to determine the potential difference in prescribing by race.
Results: The two significant predictors for ACEi/ARB/ARNIs were serum creatinine and potassium levels (n = 1556; OR 1.55 [1.37, 1.75], p < 0.0001; OR 0.67 [0.56, 0.89], p=0.0056). For beta-blockers the lone predictor was heart rate (n = 2083,OR: 1.02 [1.01, 1.03]; p=0.0001), while for MRAs the predictors were race (black vs non-black), and serum creatinine level (n = 2380, OR: 1.34 [1.06, 1.70]; p= 0.014; OR: 0.54 [0.46, 0.64]; p < 0.0001). The results of the stepwise regression provided the variables on which we were able to successfully match black and non-black patients via optimal fixed ratio matching. Overall, there were 269 black patients matched to 269 non-black patients with similar propensity scores (mean difference = 0.00003, 99.9% reduction). These propensity scores were determined from the most recent systolic blood pressure, heart rate, serum creatinine and potassium level. After matching, it was determined that blacks had a higher prescription rate of ACEi/ARB/ARNI compared to non-black patients (77.70% vs 69.52%; OR 1.53 [1.04, 2.25]; p=0.03). For beta-blockers and MRAs, there were no significant differences between blacks and non-blacks. Beta-blockers were prescribed in 85.9% of black patients vs 85.1% of non-black patients (OR 1.06 [0.66, 1.72]; p=0.81), and MRAs were prescribed in 52.8% of black patients vs 47.2% of non-black patients (OR 1.25 [0.89, 1.75]; p=0.20).
Conclusion: Prescribing rates did not differ based on whether the patient self-identified as black or non-black at an academic medical center. After matching based on predictors of GDMT prescribing, black patients were more likely to be treated with an ACEi/ARB/ARNI’s when compared to non-black patients.
Methods: This was a cross-sectional study of prescribing trends for HFrEF patients in Michigan Medicine’s Heart Failure Registry. Medication class (angiotensin-converting enzyme inhibitors [ACEi]/angiotensin II receptor blockers [ARB]/ angiotensin receptor neprilysin inhibitors [ARNI], beta-blockers, mineralocorticoid receptor antagonists [MRA]), sex, race, serum creatinine, potassium, systolic blood pressure, and heart rate were documented for each patient. First, stepwise logistic regression was used to determine the predictors of GDMT prescribing. Next, blacks and non-blacks were propensity matched based on those predictors of GDMT prescribing to determine the potential difference in prescribing by race.
Results: The two significant predictors for ACEi/ARB/ARNIs were serum creatinine and potassium levels (n = 1556; OR 1.55 [1.37, 1.75], p < 0.0001; OR 0.67 [0.56, 0.89], p=0.0056). For beta-blockers the lone predictor was heart rate (n = 2083,OR: 1.02 [1.01, 1.03]; p=0.0001), while for MRAs the predictors were race (black vs non-black), and serum creatinine level (n = 2380, OR: 1.34 [1.06, 1.70]; p= 0.014; OR: 0.54 [0.46, 0.64]; p < 0.0001). The results of the stepwise regression provided the variables on which we were able to successfully match black and non-black patients via optimal fixed ratio matching. Overall, there were 269 black patients matched to 269 non-black patients with similar propensity scores (mean difference = 0.00003, 99.9% reduction). These propensity scores were determined from the most recent systolic blood pressure, heart rate, serum creatinine and potassium level. After matching, it was determined that blacks had a higher prescription rate of ACEi/ARB/ARNI compared to non-black patients (77.70% vs 69.52%; OR 1.53 [1.04, 2.25]; p=0.03). For beta-blockers and MRAs, there were no significant differences between blacks and non-blacks. Beta-blockers were prescribed in 85.9% of black patients vs 85.1% of non-black patients (OR 1.06 [0.66, 1.72]; p=0.81), and MRAs were prescribed in 52.8% of black patients vs 47.2% of non-black patients (OR 1.25 [0.89, 1.75]; p=0.20).
Conclusion: Prescribing rates did not differ based on whether the patient self-identified as black or non-black at an academic medical center. After matching based on predictors of GDMT prescribing, black patients were more likely to be treated with an ACEi/ARB/ARNI’s when compared to non-black patients.
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