Retrospective Evaluation and Analysis of Pharmacoequity with Guideline-directed Medical Therapy in Heart Failure with Reduced Ejection Fraction (REAP-HF).

Abstract

Introduction: Patients with heart failure with reduced ejection fraction (HFrEF) who are optimized on guideline-directed medical therapy (GDMT) have improved outcomes; however, medication access and affordability are potential barriers to achieving pharmacoequity. This study sought to compare rates of HFrEF GDMT prescribing at hospital discharge across prescription insurance status groups. Methods: This was a single-center, retrospective cohort study of adult HFrEF patients. Patients were grouped according to prescription insurance status. The primary outcome was the percentage of HFrEF patients prescribed quadruple GDMT at hospital discharge. Key secondary outcomes included the presence of contraindications to therapy and 30-day all-cause readmission rates. The study was approved by the Institutional Review Board at the University of Tennessee Health Science Center. Results: Among the 200 included patients, 63% were male and 92% were black. Discharge on quadruple GDMT across insurance groups was 18% for Medicare Part D, 24% for Medicaid, 24% for commercial, and 33% for uninsured. There was no difference between insurance groups in rates of prescribed quadruple GDMT at hospital discharge (p=0.302) or 30-day hospital readmission (p=0.665). Additionally, there was a significant increase in the number of uninsured patients on quadruple GDMT after hospitalization compared to pre-hospitalization (13% vs 33%, p=0.002). Eighty percent of all patients had a contraindication to at least one GDMT agent. Conclusion: There was no difference in rates of prescribed quadruple GDMT at hospital discharge based on insurance status. However, this study did elucidate the impact of medication access programs improving pharmacoequity in the uninsured patient population.