ArticleCirculation. Heart failure2025
Social Determinants of Health and Disparities in Guideline-Directed Medical Therapy Optimization for Heart Failure.
Article in Circulation. Heart failure, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 1 of them a synthesis that pooled it.
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Who cites it
12 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Disparities in GLP-1RA and SGLT2i Uptake: a Systematic Review and an Equity-First Framework for Cardiovascular-Kidney-Metabolic Care.Current cardiology reports · 2026Pooled it
- Patient Perceptions of a Digitally Enabled Community Health Worker Intervention: Qualitative Study Among Pilot Trial Participants.JMIR cardio · 2026Trial
- The impact of an adaptive patient-centered web application on medication optimization in patients with HFrEF: Rationale and design of the SmartHF trial.American heart journal plus : cardiology research and practice · 2026Article
- Gaps in Guideline-Directed Medical Therapy for Heart Failure: A Cross-Sectional Study in an Underserved Population.Cureus · 2026Article
- Transforming Advanced Heart Failure Programs: Addressing Institutional and Systemic Drivers of Racial and Ethnic Disparities in Care.Circulation. Heart failure · 2026Review
- Design, Characteristics, and Implementation of the Financial Support for Low-Income Patients with Heart Failure Trial.JACC. Advances · 2026Article
- Heart Failure in Kidney Transplant Recipients: Narrative Review of Risk Factors, Therapy, and Current Gaps in Management.Cardiology and therapy · 2026Review
- Factors associated with the development of severe mitral regurgitation in patients with heart failure.Open heart · 2026Article
- Sociotechnical Needs of Registered Nurses in the Heart Failure Hospitalizations of African American Patients: Cross-Sectional Study.JMIR nursing · 2025Observational
- Review
- Advancing Heart Failure Care Through Disease Management Programs: A Comprehensive Framework to Improve Outcomes.Journal of cardiovascular development and disease · 2025Review
- Prevalence of prescription medication use that can exacerbate heart failure among US adults with heart failure.Pharmacotherapy · 2025Article
Corrections and comments
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Authors and funding
12 authors.
Funding
Abstract
backgroundFewer than 20% of eligible patients with heart failure with reduced ejection fraction receive all 4 pillars of guideline-directed medical therapy. Understanding disparities by race, ethnicity, sex, and adverse social determinants of health is necessary to equitably optimize quadruple therapy.
methodsUtilizing the American Heart Association's Get With The Guidelines-Heart Failure registry, we examined associations between race and ethnicity, sex, and adverse social determinants of health (insurance type and documented social need [any barrier to accessing health care]) with quadruple therapy optimization (QTO) in patients with heart failure with reduced ejection fraction hospitalized between July 1, 2021, and September 30, 2023, with complete medication data at discharge. We calculated adjusted mean differences (AMDs) in the discharge QTO score (range, 0%-100%) reflecting the proportion of eligible use of renin-angiotensin system inhibitors, β-blockers, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter-2 inhibitors and compared across demographic and adverse social determinants of health groups.
resultsAmong 82 637 patients (median age, 66 years; 32.5% female; 57.0% non-Hispanic White; 76.4% prior heart failure with reduced ejection fraction), the overall mean QTO score was 56.2% (SD, 25.5). After adjustment, compared with non-Hispanic White individuals, Black (AMD, 2.56 percentage points [95% CI, 2.16-2.96]) and Hispanic individuals (AMD, 0.71 percentage points [95% CI, 0.11-1.31]) had higher QTO scores. Females had higher QTO scores than males (AMD, 1.94 percentage points [95% CI, 1.58-2.31]). Patients with no insurance (AMD, -4.90 percentage points [-5.62 to -4.17]), Medicaid (AMD, -0.45 percentage points [-0.89 to -0.01]), and Medicare (AMD, -1.64 percentage points [-2.10 to -1.18]) had lower QTO scores versus private insurance. Those with an identified social need (n=24 651) had lower QTO scores than those without (AMD, -3.40 percentage points [95% CI, -4.10 to -2.71]).
conclusionsDisparities in QTO were most evident for patients with no insurance, Medicaid, Medicare, or potentially an identified social need. Future efforts should focus on reducing gaps to improve equitable guideline-directed medical therapy use.
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