Table 2.
Characteristics Associated with Receipt of Angiotensin Receptor Neprilysin Inhibitor in Medicare Beneficiaries with Heart Failure with Reduced Ejection Fraction
| Characteristics | Initiation of ARNI (vs ACE Inhibitor or ARB)a |
||
|---|---|---|---|
| ARNI | ACE Inhibitor or ARB | OR (95% CI) | |
| Sample size, n | 4547 | 33868 | |
| Age category, % | |||
| 65 to <75 years old | 43.5 | 44.5 | Reference |
| 75 to <85 years old | 43.2 | 39.9 | 1.08 (1.01, 1.16) |
| ≥85 years old | 13.3 | 15.7 | 0.89 (0.80, 0.99) |
| Male, % | 79.5 | 75.8 | 1.27 (1.17, 1.39) |
| Race, % | |||
| White | 82.5 | 80.9 | Reference |
| Black | 11.4 | 12.7 | 0.98 (0.88, 1.09) |
| Other | 6.1 | 6.5 | 1.02 (0.89, 1.17) |
| Dual eligibility, % | 17.4 | 23.8 | 0.76 (0.70, 0.83) |
| Gagne comorbidity index, mean (SD) | 7.2 (3.3) | 7.3 (3.5) | 0.96 (0.95, 0.98) |
| Cardiovascular comorbidities, % | |||
| Atrial fibrillation | 64.6 | 60.4 | 1.07 (1.00, 1.15) |
| Myocardial infarction | 27.2 | 29.0 | 0.98 (0.91, 1.05) |
| Hypertension | 98.0 | 98.3 | 0.81 (0.63, 1.03) |
| Stroke or transient ischemic attack | 27.1 | 30.3 | 0.94 (0.88, 1.02) |
| Non-cardiovascular comorbidities, % | |||
| ADRD | 20.8 | 25.4 | 0.88 (0.81, 0.96) |
| Anemia | 80.5 | 80.3 | 1.10 (1.01, 1.20) |
| Cancer | 19.8 | 20.3 | 1.01 (0.93, 1.09) |
| Chronic kidney disease | 78.7 | 76.2 | 1.12 (1.03, 1.23) |
| COPD | 58.4 | 58.0 | 1.09 (1.01, 1.16) |
| Depression | 42.4 | 44.5 | 1.02 (0.95, 1.09) |
| Diabetes | 66.7 | 68.5 | 0.93 (0.87, 1.00) |
| Frailty | 53.2 | 59.8 | 0.87 (0.81, 0.94) |
| Hip or pelvic fracture | 3.8 | 5.1 | 0.83 (0.70, 0.98) |
| Osteoporosis | 13.6 | 15.5 | 1.01 (0.91, 1.11) |
| Rheumatoid arthritis or osteoarthritis | 69.3 | 68.3 | 1.07 (0.99, 1.15) |
| Cardiovascular care, % | |||
| Cardiology visit within 30 days | 72.5 | 68.2 | 1.25 (1.16, 1.34) |
| HF hospitalization ≥2 in prior year | 15.8 | 14.3 | 1.41 (1.27, 1.56) |
| HF hospitalization within 30 days | 10.1 | 12.4 | 0.62 (0.56, 0.70) |
| Other heart failure medications, % | |||
| Evidence-based beta-blockers | 88.9 | 87.7 | 1.03 (0.93, 1.14) |
| Mineralocorticoid receptor antagonists | 43.1 | 29.8 | 1.68 (1.57, 1.80) |
| Hydralazine | 12.5 | 12.1 | 0.95 (0.85, 1.06) |
| Isosorbide dinitrate | 5.7 | 4.4 | 1.37 (1.17, 1.60) |
| Loop diuretics | 82.3 | 74.4 | 1.51 (1.38, 1.65) |
Abbreviations: ACE, angiotensin converting enzyme; ADRD, Alzheimer’s disease and related dementia; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor neprilysin inhibitor; CI, confidence interval; COPD, chronic obstructive pulmonary disease; HF, heart failure; OR, odds ratio; SD, standard deviation.
a
Initiators were defined as beneficiaries who filled the prescription of ARNI vs ACE inhibitors or ARB without prior fills of any drug in ARNI, ACE inhibitor, or ARB classes in the previous year.