Heart failure & cardiomyopathies
Social Determinants of Health and Disparities in Guideline-Directed Medical Therapy Optimization for Heart Failure
Authors' conclusion
Disparities in QTO were most evident for patients with no insurance, Medicaid, Medicare, or potentially an identified social need.
Study context
- Population
- Patients with HFrEF hospitalized July 1, 2021–September 30, 2023, with complete medication data at discharge
- Participants
- 82,637 patients
- Exposure
- Quadruple therapy optimization (QTO) score across race and ethnicity, sex, insurance type and documented social need
- Social needn = 24,651
- Outcome
- Discharge QTO score (range, 0%-100%): proportion of eligible use of RAS inhibitors, β-blockers, MRAs and SGLT2 inhibitors
- Follow-up
- Discharge
Methodological detailsregistry-based (AHA Get With The Guidelines-Heart Failure)
- Registry-based (AHA Get With The Guidelines-Heart Failure)
Main finding
As reported in the abstract
Discharge QTO score
AMD, percentage points (95% CI)
Black vs Non-Hispanic White
2.56(2.16–2.96)
Hispanic vs Non-Hispanic White
0.71(0.11–1.31)
Females vs Males
1.94(1.58–2.31)
No insurance vs Private insurance
−4.90(−5.62 to −4.17)
Medicaid vs Private insurance
−0.45(−0.89 to −0.01)
Medicare vs Private insurance
−1.64(−2.10 to −1.18)
Social need vs No social need
−3.40(−4.10 to −2.71)
- Overall mean QTO score
- 56.2% (SD, 25.5)
Observational data: associations, not effects.
Original publication
Social Determinants of Health and Disparities in Guideline-Directed Medical Therapy Optimization for Heart Failure. Circ Heart Fail. Published 11 November 2024. doi:10.
Summarised from the published abstract; every number is checked against it