Guideline Directed Medical Therapies Among Heart Failure Patients Enrolled In Cardiac Rehabilitation

Document Type

Conference Proceeding

Publication Date

1-1-2025

Publication Title

J Card Fail

Abstract

Background: Heart failure with reduced ejection fraction (HFrEF) guideline-directed medical therapy (GDMT) is lifesaving though medical optimization occurs rarely and slowly. With frequent in-person assessments, cardiac rehabilitation (CR) could be an important opportunity for GDMT optimization. We sought to describe prescribed GDMT among CR enrollees with HFrEF. We hypothesized that GDMT optimization would be low throughout CR. Methods: We queried the University of Michigan EMR and identified patients with most recent (within 12 months) LVEF ≤ 40% and a primary diagnosis of HF who attended CR between January, 2016 and August, 2023. We defined CR cycles as at least 6 CR sessions with no greater than 6 months between consecutive sessions. Using a previously validated algorithm, we generated medication optimization scores (MOS) at the first and final CR session within each cycle. Inputs for the algorithm used data closest to each time point. This included HF GDMT (excluding SGLT2 inhibitors), NYHA classification (assumed NYHA class 2 or 3 HF), systolic BP (SBP), heart rate, creatinine, potassium, allergies, and race we used an SBP cutoff of 100mmHG to define eligibility for titration. The MOS is a percent between 0 (least optimized) and 100 (most optimized). Descriptive statistics were used to summarize population characteristics, and Wilcoxon Signed-Rank analysis was used to compare MOSs at the start and end of CR. Results: 172 CR cycles were completed by 152 patients (63.8% male, 78.3% White, mean age 67.5 [SD 12.1] years), including 18 patients who completed 2 CR cycles and 2 who completed 3 CR cycles (Table 1). The mean number of sessions per CR cycle was 26.3 (SD 10.6). At the end of CR, 85 (49.4%) patients were on a beta-blocker, 84 (48.8%) an ACE inhibitor/ARB/ARNI, and 31 (18.0%) an MRA. After accounting for contraindications to GDMT, patients were eligible for initiation or uptitration of at least 1 class of GDMT at the end of 144 (83.7%) CR cycles (Table 1). The median MOS at the start of CR was 39% (IQR 14 - 57) and at the end of CR was 35% (IQR 14 - 57) (p= 0.79). Conclusion: GDMT utilization among patients with HFrEF participating in CR is suboptimal and does not improve over time in routine practice. There is substantial opportunity to develop and validate strategies to improve GDMT prescribing during CR.

Volume

31

Issue

1

First Page

252

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