Submission
| Title: | Compounding Disparities: Patients Presenting to the Emergency Department for Acute Heart Failure with Medication Non-adherence Are Less Likely to be Prescribed Guideline-Appropriate Medical Therapies |
| Presenter: | Karlee Waugh |
| Institution: | University of Notre Dame |
| Authors: | Nicholas E. Harrison, MD – Department of Emergency Medicine Matthew Durthaler – Indiana University School of Medicine Madeline Woodson – Decatur Central High School |
Abstract
| Background/Significance/Rationale: | Acute decompensated heart failure (ADHF) accounts for over 1 million emergency department (ED) visits and hospitalizations in the US annually. Adherence to guideline-directed medical therapies (GDMT) for chronic heart failure (HF) is a common precipitant of ADHF. Our objective was to characterize the relationship between medication non-adherence and pre-hospital prescribing patterns for GDMT among ED presentations for ADHF. |
| Methods: | We reviewed 2807 ED encounters screened by diagnostic codes, of which 344 had a diagnosis of ADHF after two-rater adjudication. AHA/ACC guidelines for GDMT were used to determine appropriate medication 1) prescription, and 2) adherence ≤14 days prior to the ED encounter, based on the patients’ pre-ED classification of HF with preserved ejection fraction (HFpEF) vs. HF with reduced EF (HFrEF). Adherence was further subclassified by specific medication, and stratified before/after the 2022 AHA HF guideline update. Logistic regression compared adherence status to predictors including rates of GDMT prescription, other clinical factors, and demographics. |
| Results/Findings: | Medication non-adherence was a factor in 53 (18%) patients. Non-adherent patients were less than half as likely as adherent patients to be prescribed appropriate GDMT (26% vs. 57%, p<0.001). After multivariable adjustment for age, sex, HFrEF vs. HFpEF, Get-With-The-Guidelines HF risk score, severity of edema on ED examination, and Charlson Comorbidity Index, non-adherent patients with HFrEF were over 3 times less likely to have been prescribed the appropriate GDMT prior to the ED visit, and patients with HFpEF >10 times less likely (both p<0.01). Medication non-adherence was also associated with worse edema, but lower risk scores, at ED presentation (p<0.05). |
| Conclusions/Discussion: | Patient medication non-adherence and prescriber non-adherence to GDMT are highly prevalent among ED presentations for ADHF, and strongly associated with one another. |
| Translational/Human Health Impact: | Increased efforts to facilitate GDMT and assist patients with medication adherence are needed to improve HF quality of care. |
