Out-of-Pocket Costs Affect GDMT in Heart Failure with Anand Shah, MD, MBA

Anand Shah, MD, MBA
Credit: LinkedIn


An analysis from investigators at Duke University Medical Center and the University of North Carolina at Chapel Hill School of Medicine provides new insight into the impact of out-of-pocket costs among patients with optimal intake of guideline-directed medical therapy (GDMT). . Heart failure with reduced ejection fraction (HFrEF).

Presented at the Heart Failure Society of American 2023 annual scientific meeting, the results of the study, which was a preplanned potshot analysis of a pilot study for patients admitted to non-cardiology services, suggest that there is a potential for improving GDMT prescribing. Virtual counseling interventions are generally effective only when outdoors. Out-of-pocket monthly drug costs did not exceed $100, but the investigators noted that this interaction was not statistically significant.

According to the study design, the population for analysis consisted of patients in the trial intervention arm who were subject to a virtual consultation with a certified pharmacy technician who would provide an estimate of the cost of contemporary GDMT when available and required insurance prior authorization. . The primary outcomes of interest for the study were change in modified heart failure optimal medical therapy (OMT) score based on GDMT use and change in target dose from admission to discharge according to insurance status and out-of-pocket costs.

Upon analysis, the results provided evidence of significant variability by insurance type for changes in average monthly out-of-pocket costs and OMT scores from admission to discharge. The investigators reported that change in OMT scores demonstrated a modest and non-significant positive trend with lower expected monthly costs for contemporary GDMT.

For more information on the study, its origins, findings, and how this data can be leveraged by physicians in real-world settings, HCPLive Cardiology spoke with study presenter Anand Shah, MD, MBA, cardiology and preventive medicine fellow, University of Contacted the University. North Carolina at Chapel Hill School of Medicine.

HCPLive Cardiology: Can you tell us why this would be included as a pre-planned posthoc analysis?

Shah: I think part of the background to this was that we knew there were four pillars of guideline-directed therapy for heart failure and that patients should be on these medications. Unfortunately, in clinical practice, the number of patients actually on these medications is surprisingly low. So, there’s a huge gap between patients who don’t have these drugs and those who we know would benefit from them. Obviously, there are a lot of clinical characteristics that determine whether a patient is eligible or not, but I think one area we really wanted to explore was the financial component, especially with some of the categories, Especially with SGLT2 inhibitors and the newer ARNIs. , all of which are patent protected. We wanted to see whether the costs were truly variable and whether patients could stay on these medications for now.

HCPLive Cardiology:What were the primary findings of your study?

Shah: The findings of this study provide a bigger picture perspective. Patients whose expected monthly drug costs were less than $50 or $100 were more likely to receive guideline-directed medical therapy. It is important to note that this analysis was pre-planned and ad-hoc, based on a prior study already published.

Previous studies focused on patients admitted to hospital non-cardiology services, specifically those with a history of heart failure and low ejection fraction. These patients were randomly assigned to one of two groups: one received virtual consultation from a multidisciplinary heart failure team, which recommended optimization of GDMT based on clinical factors and medical history, While the other group did not receive this intervention. In our study, we examined patients in the intervention group who received virtual consultation. As part of this advisory, we have provided estimated monthly cost for GDMT medications, particularly those related to pattern protectors.

We then analyzed changes in prescribing patterns from admission to discharge, and stratified the data based on expected out-of-pocket monthly costs. Our goal was to determine the extent of variation in prescription of guideline-directed medical therapy. The results of our analysis showed a trend toward increased GDMT adaptation from admission to discharge for patients with lower out-of-pocket monthly costs. Unfortunately, these results did not reach statistical significance. This can be attributed, in part, to the relatively small sample size, which has limited some statistical analyzes in this context.

This transcript was edited for grammar and clarity using artificial intelligence.


  1. Shah A, Mentz RJ, Kline C, et al. Impact of cost assessment in heart failure. Paper presented at: Heart Failure Society of America 2023 Annual Scientific Meeting; October 6 – 9; Cleveland, OH. Accessed October 7, 2023.

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