Table 3.
Trend of Use of Heart Failure Medications in Patients with Heart Failure and Reduced Ejection Fraction, 2015 to 2019, by Frailty
| Medications | 2015 | 2016 | 2017 | 2018 | 2019 | P-value for yearly trendb | P for yearly trend by frailtyb |
|---|---|---|---|---|---|---|---|
| ARNI | |||||||
| Frail | 0.3% | 3.3% | 7.4% | 10.7% | 13.7% | <0.001 | 0.940 |
| Non-frail | 0.4% | 3.9% | 8.6% | 12.5% | 16.4% | <0.001 | |
| ACE inhibitors | |||||||
| Frail | 53.2% | 50.9% | 47.0% | 43.6% | 40.8% | <0.001 | 0.001 |
| Non-frail | 59.3% | 57.5% | 52.9% | 49.4% | 46.1% | <0.001 | |
| ARB | |||||||
| Frail | 21.6% | 22.8% | 22.3% | 22.6% | 21.8% | 0.051 | 0.979 |
| Non-frail | 24.0% | 25.3% | 25.0% | 24.8% | 23.7% | <0.001 | |
| MRA | |||||||
| Frail | 28.4% | 30.4% | 31.0% | 31.2% | 31.6% | <0.001 | <0.001 |
| Non-frail | 28.3% | 31.6% | 33.1% | 33.5% | 34.4% | <0.001 | |
| Evidence-based beta-blockersa | |||||||
| Frail | 85.4% | 86.7% | 87.1% | 87.2% | 86.8% | <0.001 | <0.001 |
| Non-frail | 86.4% | 88.0% | 88.8% | 88.9% | 88.9% | <0.001 | |
| Hydralazine + Isosorbide dinitrate | |||||||
| Frail | 2.2% | 2.4% | 2.6% | 2.5% | 2.2% | <0.001 | 0.588 |
| Non-frail | 1.1% | 1.3% | 1.5% | 1.4% | 1.4% | 0.005 | |
| Loop diuretics | |||||||
| Frail | 73.6% | 76.7% | 77.0% | 76.3% | 75.6% | 0.477 | <0.001 |
| Non-frail | 60.2% | 65.2% | 66.2% | 65.4% | 64.0% | 0.033 | |
| All 3 of ARNI/ACE inhibitors/ARB + beta-blockers + MRA | |||||||
| Frail | 19.6% | 21.3% | 21.6% | 21.8% | 21.8% | <0.001 | <0.001 |
| Non-frail | 22.0% | 24.8% | 25.9% | 26.4% | 27.0% | <0.001 | |
| 2 of ARNI/ACE inhibitors/ARB + beta-blockers + MRA | |||||||
| Frail | 51.1% | 50.6% | 50.1% | 50.0% | 49.4% | 0.011 | 0.017 |
| Non-frail | 55.1% | 54.5% | 53.6% | 53.2% | 52.5% | <0.001 | |
| 1 of ARNI/ACE inhibitors/ARB + beta-blockers + MRA | |||||||
| Frail | 24.1% | 23.4% | 23.8% | 23.5% | 24.0% | <0.001 | <0.001 |
| Non-frail | 18.7% | 17.3% | 17.4% | 17.2% | 17.3% | <0.001 | |
| None of ARNI/ACE inhibitors/ARB + beta-blockers + MRA | |||||||
| Frail | 5.2% | 4.7% | 4.6% | 4.6% | 4.8% | <0.001 | <0.001 |
| Non-frail | 4.2% | 3.4% | 3.2% | 3.2% | 3.2% | <0.001 | |
Abbreviations: ACE, angiotensin converting enzyme; ARB, angiotensin receptor blockers; ARNI, angiotensin receptor neprilysin inhibitor; MRA, mineralocorticoid receptor antagonists.
Evidence-based beta-blockers include carvedilol, metoprolol succinate, and bisoprolol.
The receipt of a heart failure medication class or GDMT was modeled as a function of year (continuous variable), frailty status (binary), and their interaction term, adjusting for age, sex, race, dual eligibility, Alzheimer’s disease and related dementias, anemia, atrial fibrillation, cancer, chronic kidney disease, chronic obstructive pulmonary disease, depression, diabetes, hip or pelvic fracture, hypertension, myocardial infarction, osteoporosis, rheumatoid arthritis or osteoarthritis, and stroke or transient ischemic attack, Gagne combined comorbidity index, cardiology visit within the past 30 days, ≥2 heart failure hospitalizations within the past year, and heart failure hospitalization within the past 30 days, using generalized estimating equation logistic regression with exchangeable correlation structure to account for correlation within the same individuals.