Abstract P1072: Underutilization of Novel Guideline-Directed Medical Therapy in Patients with Heart Failure

Abstract

Background: Guideline directed medical therapy (GDMT) for patients with heart failure (HF) now includes SGLT2i and ARNI regardless of ejection fraction. Despite strong evidence supporting these therapies, their utilization among HF patients remains unclear. This study used healthcare claims data to examine the utilization of GDMT in a contemporary cohort of newly diagnosed HF patients. Methods: We analyzed claims data from commercial and Medicare Advantage plans of a large national insurer to identify patients with incident HF, diagnosed in 2022. Patients were identified as having at least two outpatient claims or one inpatient HF claim, and 12 months of continuous enrollment prior to diagnosis. Pharmacy claims assessed prescription fill rates for novel and standard GDMT (including SGLT2i, ARNI, ACEI/ARB, BB, MRA, and GLP-1 RA). Results: The analytic cohort included 163,596 patients (49% male) diagnosed with new-onset HF, with two-thirds in the outpatient setting ( Table ). HF incidence was higher with older age, with over half of cases in adults aged ≥75 years. Comorbidities were prevalent, particularly hypertension (88%), diabetes (42%), and history of myocardial infarction (50%). Beta-blockers (55%) were most frequently used, while ACEi/ARB (24%) and MRAs (11%) were less commonly used. ARNI, SGLT2i and GLP-1 RA use remained low (5% each). Conclusion: In a privately insured sample with a new diagnosis of HF, use of novel GDMT was very low. Understanding treatment patterns by HF subtype and identifying gaps in GDMT utilization are critical for developing targeted strategies to improve HF management.