Table 7.

Predictors of ARNI Prescription at Hospital Discharge

	Odds Ratio	95% Confidence Intervals		Lambda	p-value
	Odds Ratio	Lower	Upper	Lambda	p-value
Age*	0.988	0.985	0.991	0.256	<0.001
Sex (Comparison Group: Male)
Female	0.975	0.910	1.045	0.194	0.474
Race (Comparison Group: Caucasian)
Asian	1.285	1.011	1.632	0.163	0.041
Black	1.115	1.013	1.227	0.277	0.026
Hispanic	1.264	1.096	1.460	0.235	0.001
Other	0.942	0.778	1.140	0.136	0.536
Distress Score Quintile (Comparison Group: Prosperous)
Comfortable	0.962	0.844	1.069	0.472	0.559
Mid-Tier	0.920	0.813	1.042	0.417	0.192
At-Risk	0.880	0.769	1.007	0.404	0.064
Distressed	0.813	0.695	0.950	0.468	0.010
Zip Designation (Comparison Group: Urban)
Rural	1.111	0.962	1.284	0441	0.153
Small town	1.054	0.915	1.284	0.368	0.469
Suburban	1.051	0.944	1.170	0.428	0.365
Insurance (Comparison Group: Other Non-Medicare/Medicaid Insurance)
Medicaid	0.824	0.744	0.913	0.212	<0.001
Medicare	0.968	0.890	1.051	0.198	0.437
None	0.597	0.496	0.717	0.354	<0.001
Ejection fraction^†	0.937	0.933	0.941	0.190	<0.001
Discharge Serum Creatinine*	0.747	0.692	0.807	0.723	<0.001
Discharge Serum Potassium (Comparison Group: K≤5)
K>5	0.887	0.679	1.158	0.562	0.379
Discharge Systolic Blood Pressure (Comparison Group: sBP≥90)
sBP<90	0.815	0.631	1.052	0.340	0.117
Discharge Heart Rate (Comparison Group: HR≥60)
HR<60	1.091	0.927	1.282	0.403	0.295
No Prior Medical History (Comparison Group: No)
Yes	0.870	0.699	1.083	0.150	0.213
History of Congestive Heart Failure (Comparison Group: No)
Yes	0.947	0.865	1.036	0.335	0.235
History of Chronic Kidney Disease^‡ (Comparison Group: No)
Yes	0.809	0.714	0.915	0.480	0.001
History of End Stage Renal Disease (Comparison Group: No)
Yes	1.418	1.038	1.937	0.420	0.029
Listed for Heart Transplant (Comparison Group: No)
Yes	0.485	0.160	1.473	0.056	0.202
Taking ARNI Prior to Hospitalization (Comparison Group: No)
Yes	9.488	6.752	13.333	0.881	<0.001
Contraindication to ACEi/ARB/ARNI (Comparison Group: No)
Yes	0.113	0.104	0.124	0.347	<0.001
Received inpatient ARNI (Comparison Group: No)
Yes	72.091	58.301	89.142	0.846	<0.001
Received any inpatient inotrope (Comparison Group: No)
Yes	0.527	0.436	0.637	0.093	<0.001
Discharged with GDMT BB (Comparison Group: No)
Yes	1.818	1.634	2.022	0.237	<0.001
Discharged with ACEi or ARB (Comparison Group: No)
Yes	0.098	0.088	0.109	0.551	<0.001
Discharged with MRA (Comparison Group: No)
Yes	1.773	1.636	1.922	0.386	<0.001
Scheduled Follow Up on Discharge (Comparison Group: No)
Yes	1.172	1.001	1.373	0.261	0.050
Discharged to Continued Care^\|\| (Comparison Group: No)
Yes	0.771	0.703	0.846	0.516	<0.001
Year of Discharge (Comparison Group: Discharged in 2017)
2018	1.378	1.261	1.505	0.131	<0.001
2019	1.831	1.678	1.999	0.138	<0.001
2020	2.055	1.835	2.301	0.140	<0.001
Heart Transplant Center (Comparison Group: No)
Yes	0.555	0.347	0.887	0.023	0.014
Academic Center^§ (Comparison Group: No)
Yes	1.178	0.939	1.478	0.068	0.158
Intercept	0.100	0.075	0.134	0.298	<0.001

Results obtained via mixed-effect logistic regression model with a random intercept assigned to hospital site. Missing data were handled by multilevel multiple imputation. Coefficients and 95% confidence intervals are presented as odds ratios. Unless otherwise indicated by an asterisk, odds ratios are relative to the defined comparison group. Variables denoted by a single asterisk (*) are continuous variables and indicate a change in the odds ratio per 1-unit change in the continuous variable, with the exception of (†) ejection fraction, where the estimate indicates the change in odds ratio per 5% change in ejection fraction. Lambda indicates the proportion of variation due to missing data.

All continuous variables have been grand mean centered, so the intercept can be interpreted as the odds of being prescribed an ARNI with all categorical variables assuming their baseline comparison group value and all continuous variables at their mean value. (‡) A history of chronic kidney disease is defined by the GWTG data dictionary as a serum creatinine >2mg/dL. (§) Academic centers were defined by the presence of resident post-graduate physicians. (||) For the variable “Discharged to Continued Care”, continued care is defined as home health care, skilled nursing facility, inpatient rehabilitation, intermediate care facility, long term acute care facility, or another acute care facility.

ACEi: angiotensin-converting enzyme inhibitor; ARB: angiotensin-receptor blocker; ARNI: angiotensin receptor-neprilysin inhibitor; BB: beta blocker; GDMT: guideline-directed medical therapy; HR: heart rate; K: potassium, MRA: mineralocorticoid receptor angtagonist; sBP: systolic blood pressure.