Background: Guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction includes angiotensin receptor-neprilysin inhibitors (ARNi) or angiotensin receptor blockers (ARB), beta-blockers, mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter-2 inhibitors (SGLT2i). Despite proven reductions in morbidity and mortality, GDMT uptake remains suboptimal. The Observational Health Data Sciences and Informatics (OHDSI) network, which maintains the Observational Medical Outcomes Partnership (OMOP) common data model, facilitates health system-level assessment of gaps in GDMT which can drive quality improvement.
Objectives: To characterize utilization of GDMT among individuals with congestive heart failure (CHF) in one diverse health system before and after the newest guideline release in early 2022.
Methods: We developed two cohorts from our system’s OMOP CDM with data from 42 clinics delivering adult primary care. The first cohort included patients newly coded as having CHF between 2020 and April 2022, with a 1-year CHF-free window preceding the index date, while the second included patients with a first code after April 2022. CHF identification was based on the OHDSI Phenotype Library codes available in Github, refined by clinical experts. Medication class utilization (ARNi/ARB, beta-blockers, MRA, SGLT2i) was assessed using prescription records within 365 days after diagnosis. Analyses were conducted using ATLAS and R.
Results: The study included 9610 patients before and 5820 after April 2022. The later cohort was slightly older: patients aged 65–84 (50.3% vs. 52.0%) and >85 (14.6% vs. 15.6%) with fewer women (53.0% vs 50.9%). The racial distribution shifted, with White patients increasing from 50.9% to 57.4% and Black patients decreasing from 42.9% to 34.8%, while insurance coverage increased from 76.4% to 79.6%, and comorbidities such as hypertension (78.5% vs. 77.1%) and hyperlipidemia (68.5% vs. 71.4%) remained prevalent. Overall, 4348 individuals (45.2%) pre-2022 and 2288 (39.3%) post-2022 were prescribed any of these four classes of medications. Medication utilization decreased for beta-blockers (62.9% to 54.7%) but increased for ARNi/ARB (28.9% to 35.6%), MRA (19.0% to 22.9%), and SGLT2i (8.0% to 21.8%).
Conclusions: Increased use of ARNi or ARB, MRA, and SGLT2i post-April 2022 suggests a positive shift toward GDMT. However, longitudinal analysis and investigation in subgroups are necessary to fully understand treatment patterns and potential barriers to treatment access. The OMOP common data model provides a robust foundation for identifying care gaps and informing system-level interventions to align practice with guidelines.
