Use of Guideline-directed Medical Therapy in Patients ≥65 years after the Diagnosis of Heart Failure: A Canadian Population-based Study

• Author / Creator

  Wahid, Muizz

• Background: Guideline-directed medical therapy (GDMT) improves clinical outcomes in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Despite proven efficacy, GDMT are under-utilized in clinical practice. The current study examines GDMT utilization after incident hospitalization for HF to promote medication initiation, and titration to target dosing within a reasonable time-period.

  Methods: This observational study identified 66,372 patients with HFrEF with age ≥65 years and an incident HF hospitalization using administrative health data (2013-2018). GDMT (angiotensin converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), angiotensin receptor-neprilysin inhibitors (ARNI), β-blockers (BB), and mineralocorticoid receptor antagonists (MRA) received within the 6 months after hospitalization was evaluated by monitoring therapy combinations, optimal dosing (proportion receiving ≥50% of the target dose for ACEi/ARB/ARNI, and BB, and any dose of MRA), maximal and last dose assessed, and through a GDMT intensity score.

  Results: Among patients with HFrEF, 4768 (7.2%) were on no therapy, 17,184 (25.9%), were on monotherapy, 30,912 (46.6%) were on dual therapy, 13,508 (20.4%) were on triple therapy. Only 8747 (13.2%) and 5484 (8.3%) achieved optimal GDMT based on the maximum dose and last dispensed dose, respectively, within 6 months post-discharge. Finally, 38,869 (58.6%) achieved <50% of the maximum intensity score, 23,006 (34.7%) achieved between 50-74% of the maximum intensity score, and 4497 (6.8%) achieved a score ≥75% of the maximum intensity score.
  Conclusions: Current pharmacological management for patients with HFrEF does not align with the existing Canadian guidelines. Considering the gap in care, innovative strategies to optimize care in patients with HFrEF are needed.

• Subjects / Keywords

  • heart failure
  • GDMT
  • HFrEF

• Graduation date

  Fall 2023

• Type of Item

  Thesis

• Degree

  Master of Science

• DOI

  https://doi.org/10.7939/r3-yexe-ht39

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.