Trends in In-Hospital GDMT Initiation in Medicare Beneficiaries with Heart Failure, with Ankeet Bhatt, MD, MBA

An analysis of the Get With The Guidelines®-Heart Failure (GWTG-HF) registry is offering clinicians insight into trends in medical therapy before, during, and after hospitalization among Medicare beneficiaries with heart failure and diabetes.

Results of the study, which included data from more than 35,000 Medicare beneficiaries, suggest in-hospital initiation of guideline-directed medical therapy (GDMT) was common among hospitals participating in the GWTG-HF registry, but notable room for improvement remains.

A voluntary quality improvement program launched by the American Heart Association in 2005, the GWTG-HF provides participating hospital with a web-based IQVIA Registry platform. For the current study, investigators performed a search of data collected from Medicare beneficiaries hospitalized between July 2014 and September 2019 with Part D prescription coverage.^1,2

The primary outcomes of interest were medication fills at 6 and 3 months before hospitalization, at hospital discharge, and 3 months post-discharge. Medication classes of interest included 7 classes of antihyperglycemic therapies and 4 classes of heart failure therapies. The antihyperglycemic class of interest were metformin, sulfonylureas, GLP-1RA, SGLT2-inhibitors, DPP-4 inhibitors, thiazolidinediones, and insulins. The heart failure classes of interest were evidence-based β-blockers, ACEi or ARB, MRA, and ARNI.¹

Overall, 35,165 Medicare beneficiaries were identified for inclusion. This cohort had a median age of 77 tears, 54% were women, and 76% were White. Among the cohort, 33% had an ejection fraction of 40% or less, 11% had an ejection fraction of 41-49%, and 56% had an ejection fraction of 50% or greater.¹

Upon analysis, results suggested insulin was the most prescribed antihyperglycemic medication prescribed following a heart failure hospitalization, with 37% of participants prescribed insulin. Following insulin was metformin (21%) and sulfonylureas (20%). Investigators highlighted the rate of GLP-1 receptor agonist and SGLT2 inhibitor use was low and did not improve over time.¹

In a subgroup of patients with heart failure with reduced ejection fraction, investigators observed fill rates of 63%, 62%, 19%, and 4% for evidence-based β-blocker, RASi, MRA, and ARNI, respectively at 6 months. Investigators also pointed out fills initially declined prior to hospitalization but rose from 3 months before hospitalization to discharge for evidence-based β-blocker, RASi, MRA, ARNI, and triple therapy (P for all <.01).¹

As part of on-site coverage of the Heart Failure Society of American 2023 Annual Scientific Meeting, the editorial team of HCPLive Cardiology sat down with lead investigator Ankeet Bhatt, MD, MBA, of Kaiser Permanente, to learn more about this study, the results, and how he interprets the findings. That conversation is the subject of the following video.

Bhatt has no relevant disclosures.

References:

1. Bhatt AS, Fonarow GC, Greene SJ, et al. Medical Therapy Before, During, and After Hospitalization in Medicare Beneficiaries with Heart Failure and Diabetes: The Get With The Guidelines - Heart Failure Registry [published online ahead of print, 2023 Sep 25]. J Card Fail. 2023;S1071-9164(23)00344-5. doi:10.1016/j.cardfail.2023.09.005
2. American Heart Association. Get with the guidelines® - heart failure registry tool. www.heart.org. February 27, 2023. Accessed October 9, 2023. https://www.heart.org/en/professional/quality-improvement/get-with-the-guidelines/get-with-the-guidelines-heart-failure/get-with-the-guidelines-hf-registry-tool.