Temporal Shifts in Guideline-directed Medical Therapy Prescribed at Discharge to Heart Failure Patients in A Large US Integrated Health System

Introduction While multiple therapies known to improve clinical outcomes in heart failure (HF) exist, they remain underutilized. Because hospitalization provides a unique opportunity to address this issue, we sought to better understand temporal changes in prescription of guideline-directed medical therapy (GDMT) to patients hospitalized for HF at the time of discharge. Hypothesis We predicted an increase in prescription of GDMT, but with variability across HF types and ongoing opportunity for improvement. Methods We performed a retrospective cross-sectional analysis of patients admitted to a large integrated health system within the western US between January 1, 2018 and October 1, 2022 with a principal diagnosis of HF (defined by International Classification of Diseases, Tenth Revision [ICD-10] codes: I50.2, systolic HF; I50.3, diastolic HF; I50.4, combined systolic and diastolic HF; I11.0, hypertensive heart disease with HF; and I13.0 and I13.2, hypertensive heart disease with HF and chronic kidney disease [CKD]). Prescription rates for HF medications (evidence-based beta blocker, angiotensin converting enzyme [ACE] inhibitor/angiotensin receptor blocker [ARB]/angiotensin receptor neprilysin inhibitor [ARNI], mineralocorticoid receptor antagonist [MRA], and sodium-glucose cotransporter-2 [SGLT2] inhibitor) were assessed at discharge. Results Over nearly 5 years, 61,238 HF hospitalizations occurred, involving 43,234 patients, with 76% having only 1 hospitalization. Prescription rates of a beta blocker decreased slightly over time, with lowest rates among those with diastolic HF (Figure). Prescription rates of an ACEi or ARB largely fell across all 5 HF groups; this was offset by a rise in prescription rates for an ARNI, particularly among those with systolic HF and systolic and diastolic HF. Prescription rates of a MRA modestly rose over time for most HF groups, with lowest rates among those with diastolic HF and hypertensive heart disease with HF and CKD. Prescription rates of an SGLT2 inhibitor rose in all 5 groups, with the largest year-over-year increase between 2021 and 2022. Conclusions Despite a notable increase in the prescription rate of an ARNI and SGLT2 inhibitor over time, there remains substantial opportunity to increase use of these and other GDMT among patients hospitalized with HF.