Trends in in-hospital GDMT initiatives among Medicare beneficiaries with heart failure with Ankit Bhatt, MD, MBA


Analysis of the Get With the Guidelines®-Heart Failure (GWTG-HF) registry provides physicians with information about trends in medical treatment before, during, and after hospitalization among Medicare beneficiaries with heart failure and diabetes. Used to be.

The results of the study, which included data from more than 35,000 Medicare beneficiaries, suggest that hospital initiation of guideline-directed medical therapy (GDMT) was common among hospitals participating in the GWTG-HF registry, but that there remained significant room for improvement. happened.

A voluntary quality improvement program initiated by the American Heart Association in 2005, the GWTG-HF provides a web-based IQVIA registry platform to participating hospitals. For the current study, investigators searched data collected from Medicare beneficiaries hospitalized between July 2014 and September 2019 with Part D prescription coverage.1,2

The primary outcomes of interest were medication refills 6 and 3 months before hospitalization, at hospital discharge, and 3 months after discharge. Drug classes of interest included 7 classes of antihyperglycemic treatments and 4 classes of heart failure treatments. Antihyperglycemic classes of interest included metformin, sulfonylureas, GLP-1RAs, SGLT2-inhibitors, DPP-4 inhibitors, thiazolidinediones, and insulin. Heart failure classes of interest were evidence-based β-blockers, ACEi or ARBs, MRAs, and ARNIs.1

In total, 35,165 Medicare beneficiaries were identified for inclusion. The average age of this group was 77 years, 54% were female, and 76% were white. In the group, 33% had an ejection fraction of 40% or less, 11% had an ejection fraction of 41–49%, and 56% had an ejection fraction of 50% or greater.1

Upon analysis, the results showed that insulin was the most commonly prescribed antihyperglycemic medication after hospitalization for heart failure, with 37% of participants prescribed insulin. Insulin was followed by metformin (21%) and sulfonylureas (20%). The investigators highlighted that rates of use of GLP-1 receptor agonists and SGLT2 inhibitors were low and did not improve over time.1

In a subgroup of patients with heart failure with reduced ejection fraction, the investigators observed rates of 63%, 62%, 19%, and 4% for evidence-based β-blockers, RASI, MRA, and ARNI, respectively, at 6 months. The investigators also reported that follow-up initially declined before hospitalization, but increased from 3 months before hospitalization to discharge for evidence-based β-blocker, RASI, MRA, ARNI, and triple therapy. Went (P for all <.01).1

As part of on-site coverage of the Heart Failure Society of American 2023 Annual Scientific Meeting, the editorial team of HCPLive Cardiology Sat down with Lopez to learn more about this study, the results, and how he interprets the findings. That conversation is the subject of the following video.

Bhatt has no relevant disclosures.

Reference:

  1. Bhatt AS, Fonarow GC, Green SJ, et al. Medical therapy before, during, and after hospitalization in Medicare beneficiaries with heart failure and diabetes: Know the guidelines – Heart Failure Registry [published online ahead of print, 2023 Sep 25], j card failed, 2023;S1071-9164(23)00344-5. doi:10.1016/j.cardfail.2023.09.005
  2. American Heart Association. Get the Guidelines® – Heart Failure Registry Tool. www.heart.org. February 27, 2023. Accessed October 9, 2023. https://www.heart.org/en/professional/quality-improvement/get-with-the-guidelines/get-with-the-guidelines-heart-failure/get-guidelines-HF-registry-tool with.

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