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Sex Disparities in Use of Medical Therapy Among HFrEF Patients
Quick Takes
- In a claims-based study, only 6.2% of patients with HFrEF received optimal dose of HFrEF therapy at 12 months after diagnosis.
- Female patients were less likely to receive every class of HFrEF therapy at every time period of follow-up compared with male patients.
- Females <65 years of age and those with commercial insurance had larger disparities in receiving optimal HFrEF therapy.
Study Questions:
What are the sex differences in optimal guideline-directed medical therapy (GDMT) use within 1 year of heart failure with reduced ejection fraction (HFrEF)?
Methods:
The authors used claims data (Optum Clinformatics) and studied patients with incident HFrEF from 2016 to 2020 enrolled for over 1 year. The primary outcome of interest was time to achieve optimal GDMT defined as ≥50% target dose of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker or any dose of angiotensin receptor neprilysin inhibitor, ≥50% dose of beta-blockers, and any dose of mineralocorticoid receptor antagonist. The outcome of interest was number of days after HF diagnosis needed for a patient to fill all three medication classes at optimal dosages.
Results:
The final study cohort was comprised of 63,759 patients with a mean age of 71 years and 57% males. Compared to males, females with HFrEF were more likely to be older, with Medicare, inpatient at the time of diagnosis, and lower prevalence of comorbidities. The proportion of patients reaching optimal GDMT was low at 6.2% at 12 months. Female patients had lower uptake of optimal GDMT for every medication class at every time point within 12 months of HFrEF diagnosis, which persisted with multivariable adjustment (hazard ratio of 0.77 compared with males). Sex differences in achieving optimal GDMT at follow-up were more apparent for female patients with commercial insurance than Medicare and for younger female patients <65 years compared with older patients ≥65 years.
Conclusions:
In an analysis of claims-based data, use of optimal GDMT in HFrEF patients was low at 6.2% at 12 months of diagnosis. Females were less likely than males to receive optimal dose of every medication class at every follow-up time period, with presence of commercial insurance and age <65 years being associated with a lower probability of achieving optimal therapy.
Perspective:
Female patients with HFrEF have higher hospitalization rates and higher mortality risk than male patients. Existing studies demonstrate lower rates of GDMT use among female patients with HFrEF compared with male patients. This study provides an extension of these findings and shows lower rates of optimal GDMT for all three classes of medications at every time period within the first 12 months of HFrEF diagnosis. Accordingly, these findings suggest that implementation efforts are needed to improve therapy uptake and mitigate sex disparities. Important limitations of this study remain lack of granular clinic data such as blood pressure and illness severity that often determine ability to uptitrate medications for HFrEF.
Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure
Keywords: Guideline Adherence, Heart Failure, Sex Characteristics
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