P182 - TREATMENT PRACTICES IN HEART FAILURE WITH REDUCED EJECTION FRACTION BY SPECIALTY: AN ANALYSIS FROM THE VANCOUVER COASTAL ACUTE HEART FAILURE (VOCAL-AHF) REGISTRY

Background: Heart Failure (HF) affects over 6 million Americans and is associated with high mortality and frequent hospitalizations. Guideline directed medical therapy (GDMT) is underutilized, and apparent differences in prescribing patterns have been reported according to specialty providing care when hospitalized.

OBJECTIVE
Using the VOCAL-HF registry, we compared eligibility for ACEI/ARB, beta blocker and MRA in patients hospitalized to either Cardiology, Internal Medicine, and Family Practice, at discharge.

METHODS AND RESULTS: A quality assurance programme using retrospective chart review identified adults discharged with a primary diagnosis of HF from three acute care facilities in Vancouver, Canada, between April 2015 and December 2020. Patients were eligible for a drug if they had an indication (i.e.: HFrEF with an LVEF < 40%) and no contraindications (e.g.: hyperkalemia, or kidney impairment). Contraindications were stratified by each drug type and admitting specialty.

RESULTS
Among 2429 consecutive discharged patients, 1051/1032 had HFrEF. Patients admitted to cardiology were younger, more often male, with fewer comorbidities, and had greater access to inpatient echocardiography (Table 1). Contraindications to all therapies were less common in patients admitted to cardiology compared to internal medicine and family practice (Table 2). Disparities in uptake were evident between specialties in the population overall, respectively ACEI/ARB 68% vs 49% vs 44%, beta-blockers 87% vs 75% vs 71%, MRA 47% vs 23% vs 21%. Once adjusted for the proportion of patients both indicated and not contraindicated (i.e., true eligibility) these differences were significantly reduced though persisted for MRA use, respectively ACEI/ARB 93% vs 86% vs 67%, beta-blockers 96% vs 92% vs 92%, MRA 71% vs 46% vs 45%.

Conclusion: Eligibility for GDMT varies markedly between patients admitting to different specialties. Apparent disparities between specialties are reduced once adjusted for indication and contraindications, although persistent particularly for MRA use. This highlights the need for high quality data to adjudicate eligibility when reporting performance metrics.