Heart failure & cardiomyopathiesCohort study
Geographic Variation in the Quality of Heart Failure Care Among U.S. Veterans
- Retrospective cohort study
- national
- hospital referral region-level analysis
Authors' conclusion
Wide geographic differences exist for HFrEF care.
Study context
- Population
- US Veterans with heart failure with reduced ejection fraction (HFrEF) in the Veterans Health Administration, addresses linked to hospital referral regions (HRRs)
- Outcome
- Geographic variation in GDMT prescription (percentage prescribed and composite GDMT z-score per HRR)
- Follow-up
- July 1, 2020, to July 1, 2021
Main finding
As reported in the abstract
GDMT prescription within HRRs
- Beta-blockers, median
- 80% (IQR: 77.3%-82.2%)
- ACEi/ARB/ARNI
- 69.3%; IQR: 66.4%-72.1%
- SGLT2 inhibitors
- 10.3%; IQR: 7.7%-12.8%
- MRA
- 29.2%; IQR: 25.8%-33.9%
- ARNI
- 12.2%; IQR: 8.6%-15.3%
Observational data: associations, not effects.
Further findings
Association of HRR composite guideline-directed medical therapies (GDMT) z-score with demographic characteristics
- HRR median Gini coefficient (inverse)
- R = −0.13; P = 0.0218
- Percentage of low-income residents (inverse)
- R = −0.117; P = 0.0413
- linear regression
Original publication
Geographic Variation in the Quality of Heart Failure Care Among U.S. Veterans. JACC Heart Fail. Published 2 August 2023. doi:10.1016/j.jchf.2023.06.010
Summarised from the published abstract; every number is checked against it