ArticleEuropean heart journal open2025
Impact of socio-demographic and ethnic determinants in guideline-directed medical therapy implementation during heart failure hospitalization.
Article in European heart journal open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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20 authors.
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Abstract
Aims: To assess for the first time the impact of socio-demographic variables on prescription of guideline-directed medical therapy (GDMT) after an episode of heart failure (HF) decompensation in the Italian healthcare system. Methods and results: Utilizing 'GENERATOR-HF DataMart', a cross-sectional analysis was performed. We included patients with HF and reduced ejection fraction discharged between January 2019 and July 2024. The degree of GDMT implementation across the different socio-demographic variables (i.e. patient's age, sex, marital status, nationality, place of residence, and educational level) was evaluated through the modified optimal medical therapy (mOMT) score (i.e. a ratio between the number of pillars actually prescribed and the number of pillars that could be prescribed on the basis of each specific contraindication). A multivariable logistic regression model was also fitted to assess the association between the socio-demographic variables and the prescription of each pillar and loop diuretics. 1730 patients (median age: 72 years; 24% females) were included. The mOMT score was significantly lower in elderly patients, but comparable across other pre-specified socio-demographic categories. In multivariable regression analysis, older age was the only independent socio-demographic predictor of under-prescription both overall and for ACEi/ARB/ARNI (OR0.70; 95% CI 0.55-0.89), beta-blockers (OR0.59; 95% CI 0.41-0.84) and SGLT2i (OR0.66, 95% CI 0.47-0.93), while also associated with a loop diuretics use (OR1.56; 95% CI 1.13-2.17). A higher mOMT score was significantly associated with a reduced incidence of early adverse events (i.e. 30-day all-cause death and urgent re-admissions) (4.1% vs. 8.5%; Conclusion: Older age was the only independent predictor of under-prescription of GDMT and enhanced use of loop diuretics, whereas no discrepancies were found across the other socio-demographic subgroups.
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