Heart failure & cardiomyopathiesCohort study
Sex Disparities in Longitudinal Use and Intensification of Guideline-Directed Medical Therapy Among Patients With Newly Diagnosed Heart Failure With Reduced Ejection Fraction
- Retrospective cohort study
- administrative claims database
Authors' conclusion
Overall use of optimal GDMT after HFrEF diagnosis was low, with significantly lower use among female (compared with male) patients.
Study context
- Population
- Patients with incident heart failure with reduced ejection fraction (HFrEF), US commercial and Medicare Advantage claims database (Optum Clinformatics), 2016–2020
- Participants
- 63,759 patients
- Exposure
- Female vs male patients
- Outcome
- Use of optimal GDMT (≥50% target dose beta-blocker plus ≥50% target dose ACEi or ARB, or any dose ARNI, plus any dose MRA)
- Follow-up
- Within 12 months of HFrEF diagnosis
Main finding
Probability of achieving optimal GDMT
Hazard ratio
0.77
95% CI 0.71–0.83
P < 0.001
Female vs Male
HR 0.77 (95% CI 0.71–0.83); P < 0.001
As reported in the abstract
- Optimal GDMT achieved at 12 months, all patients
- 6.2%
Observational data: associations, not effects.
Further findings
| Outcome | HR (95% CI) | |
|---|---|---|
| Optimal GDMT, by insurance (subgroup) — Female vs Male · commercial insurance | 0.66 (0.58–0.76) | |
| Optimal GDMT, by insurance (subgroup) — Female vs Male · Medicare | 0.85 (0.77–0.92) | |
| Optimal GDMT, by age (subgroup) — Female vs Male · age <65 years | 0.65 (0.58–0.74) | |
| Optimal GDMT, by age (subgroup) — Female vs Male · age ≥65 years (as printed) | 87 (80–96) | |
| 0.050.21520Hazard ratio (log scale) |
- Optimal GDMT, by insurance (subgroup): interaction P (sex×insurance status)=0.005
- Optimal GDMT, by age (subgroup): interaction P (sex×age)=0.009
Original publication
Sex Disparities in Longitudinal Use and Intensification of Guideline-Directed Medical Therapy Among Patients With Newly Diagnosed Heart Failure With Reduced Ejection Fraction. Circulation. Published 23 January 2024. doi:10.1161/circulationaha.123.067489
Summarised from the published abstract; every number is checked against it