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. 2024 Aug 2:45:100440.
doi: 10.1016/j.ahjo.2024.100440. eCollection 2024 Sep.

Guideline-directed medical therapy prescribing patterns and in-hospital outcomes among heart failure patients during COVID-19

Pratyaksh K Srivastava  1 , Alexandra M Klomhaus  2 , Asim Rafique  1 , Pooja S Desai  3 , Lori B Daniels  4 , Clyde W Yancy  5 , Eric H Yang  1 , Gregg C Fonarow  1 , Rushi V Parikh  1
Affiliations

Guideline-directed medical therapy prescribing patterns and in-hospital outcomes among heart failure patients during COVID-19

Pratyaksh K Srivastava et al. Am Heart J Plus. .

Abstract

Study objective: The association of prior to admission guideline-directed medical therapy (GDMT) use in patients hospitalized with Heart Failure with Reduced Ejection Fraction (HFrEF, ejection fraction ≤40 %) and Coronavirus Disease 2019 (COVID-19) with in-hospital outcomes has not been well studied.

Design/setting/participants/interventions/outcome measures: Using the American Heart Association's Get With The Guidelines Heart Failure Registry, we identified HFrEF patients presenting with acute decompensated heart failure (ADHF) and compared rates of GDMT prescription between those presenting prior to and during the pandemic. In a subgroup of patients with a concomitant COVID-19 diagnosis, we evaluated the association of prior to admission GDMT use with in-hospital mortality and severe COVID-19.

Results: 23,899 patients were admitted with HFrEF during the pandemic (2/16/20-3/24/21) and 26,459 patients were admitted in the year prior (2/16/19-2/15/20). In this overall cohort, prior to admission ACEI/ARB/ARNI (45.6 % vs 48.1 %, p < 0.0001) and BB (56.9 % vs 62.4 %, p < 0.0001) use was lower among admitted HFrEF patients during the pandemic when compared to the year prior. Rates of ACEI/ARB/ARNI, MRA, and triple therapy (ACE/ARB/ARNI + BB + MRA) prescription at discharge were higher during the pandemic compared to the year prior. Among a subgroup of those with HFrEF and COVID-19 (n = 333), prior to admission GDMT use was not associated with in-hospital mortality or severe COVID-19.

Conclusion: We found no association between prior to admission GDMT use and in-hospital mortality or severe COVID-19 among HFrEF patients admitted with ADHF and COVID-19. GDMT prescription at discharge for HFrEF patients overall has remained either similar or improved during the pandemic.

Keywords: COVID-19; Guideline-directed medical therapy; Heart failure with reduced ejection fraction.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: GCF reports consulting for Abbott, Amgen, AstraZeneca, Bayer, Cytokinetics, Edwards, Eli Lilly, Johnson&Johnson, Medtronic, Merck, Novartis, and Pfizer. EHY reports research grants/funding from CSL Behring, Boehringer Ingelheim, Eli Lilly, and Bristol Meyers Squibb, and consulting fees from Pfizer. LBD reports consulting for Abbott, Quidel, and Roche; research funding from Vifor; and serves on a clinical endpoint adjudication committee for Applied Therapeutics. RVP receives unrelated research support from Infraredx, Abbott Vascular, and Bayer, and consulting fees from Abbott Vascular.

Figures

Fig. 1
Fig. 1
Population derivation. Abbreviations: COVID-19, Coronavirus Disease 2019; GWTG-HF, Get With the Guidelines Heart Failure.
Fig. 2
Fig. 2
Guideline-directed medical therapy prescribing patterns pre- (2/16/19–2/15/20) and during (2/16/20–3/24/21) COVID-19. *Denotes statistically significant difference. Abbreviations: ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor II blocker; ARNI, angiotensin receptor-neprilysin inhibitor; COVID-19, Coronavirus Disease 2019; MRA, mineralocorticoid receptor antagonist.
Fig. 3
Fig. 3
Guideline-directed medical therapy prescribing patterns during (2/16/20–3/24/21) the COVID-19 pandemic among HFrEF patients with and without COVID-19. *Denotes statistically significant difference. Abbreviations: ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor II blocker; ARNI, angiotensin receptor-neprilysin inhibitor; COVID-19, Coronavirus Disease 2019; MRA, mineralocorticoid receptor antagonist.
See this image and copyright information in PMC

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