Racial and gender inequalities exist in the use of guideline-directed medical therapy (GDMT) for heart failure, according to research presented at the CHEST Annual Meeting in Boston, Massachusetts. The study found low prescription rates for certain medications among women and a lag in up-titration among non-White patients.
GDMT is an important focus of pharmacological therapy for patients with heart failure with reduced ejection fraction (HFrEF). It involves the use of four main drug classes: renin-angiotensin system inhibitors, beta blockers, mineralocorticoid inhibitors, and sodium-glucose cotransporter-2 (SGLT2) inhibitors. The approach is supported by multiple major randomized controlled trials that found improved clinical outcomes. GDMT is most effective when a patient uses a combination of medications from the four drug classes.
The study presented at CHEST 2024 included 258 patients (174 male) who were admitted for HFrEF into three hospitals in the UPMC Health System in Pennsylvania from March 2022 to September 2023. The researchers examined differences in prescription rates and up-titration by gender and race.
The analysis found no significant differences in prescription rates for beta blockers during admission or up-titration at discharge. The study also showed no significant differences in prescription rates for sacubitril/valsartan), spironolactone, or SGLT2 inhibitors.
However, the authors found that men had better titration of angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) to therapeutic levels at discharge compared to females (10% vs 0%, P=0.2909).
Among White (n=183) and non-White (n=75) patients, there were significant differences in prescription rates of sacubitril/valsartan (29.33% vs 15.50%, P=0.0096) and spironolactone (45.33% vs 28.96%, P=0.015). Although the authors found no significant differences in up-titration to therapeutic levels of sacubitril/valsartan (14% vs 13.79%), beta blockers (6.47% vs 8.965%), or spironolactone (30.23% vs 27.66%) between White and non-White patients, there was a very significant difference for ACE/ARBs for White versus non-White patients (10% vs 0%).
“Despite higher awareness of GDMT… racial and gender inequalities still exist,” wrote the authors, led by Seema Sharma Gautam, MD. “Our results show that more emphasis should be placed on addressing gender and racial inequality along with GDMT awareness.”
Reference
Gautam SS, Khadka S, Golubykh K, et al. Gender and racial disparities in GDMT prescription and up-titration among patients with heart failure with reduced ejection fraction: a retrospective study. Abstract #A357. Presented at the CHEST Annual Meeting; October 6-9, 2024; Boston, Massachusetts.
