Table 2.
Use of Guideline-Directed Medical Therapy in the First Year After HFrEF Diagnosis
| Medication Group | Overall (n=1160) | Seen in HF Clinic in 1st Year | P value | |
|---|---|---|---|---|
| No (n=780) | Yes (n=380) | |||
| Beta blocker | ||||
| Prior to HFrEF | 345 (29.7%) | 236 (30.3%) | 109 (28.7%) | <0.001 |
| Not eligible | 148 (12.8%) | 106 (13.6%) | 42 (11.1%) | |
| Initiated in first year | 592 (51.0%) | 370 (47.4%) | 222 (58.4%) | |
| Eligible, did not receive in first year | 75 (6.5%) | 68 (8.7%) | 7 (1.8%) | |
| HF beta blocker | ||||
| Prior to HFrEF | 133 (11.5%) | 84 (10.8%) | 49 (12.9%) | <0.001 |
| Not eligible | 178 (15.3%) | 130 (16.7%) | 48 (12.6%) | |
| Initiated in first year | 494 (42.6%) | 268 (34.4%) | 226 (59.5%) | |
| Eligible, did not receive in first year | 355 (30.6%) | 298 (38.2%) | 57 (15.0%) | |
| ACEi/ARB/ARNI | ||||
| Prior to HFrEF | 342 (29.5%) | 232 (29.7%) | 110 (29.0%) | <0.001 |
| Not eligible | 142 (12.2%) | 102 (13.1%) | 40 (10.5%) | |
| Initiated in first year* | 544 (46.9%) | 328 (42.1%) | 216 (56.8%) | |
| Eligible, did not receive in first year | 132 (11.4%) | 118 (15.1%) | 14 (3.7%) | |
| MRA | ||||
| Prior to HFrEF | 24 (2.1%) | 14 (1.8%) | 10 (2.6%) | <0.001 |
| Not eligible | 135 (11.6%) | 95 (12.2%) | 40 (10.5%) | |
| Initiated in first year | 156 (13.5%) | 68 (8.7%) | 88 (23.2%) | |
| Eligible, did not receive in first year | 845 (72.8%) | 603 (77.3%) | 242 (63.7%) | |
ACEi= angiotensin converting enzyme inhibitor; ARB= angiotensin receptor blocker; ARNI= angiotensin receptor neprilysin inhibitor; MRA= mineralocorticoid receptor antagonist
*
A total of 13 patients diagnosed with HFrEF after July 2015 (sacubitril valsartan FDA approval date) were initiated on ARNI in the first year