Abstract 16586: Differences in Medical Care Across the Left Ventricular Ejection Fraction Spectrum Following New Heart Failure Diagnosis in a US Healthcare System

Introduction: Heart failure (HF) is a major public health concern with increasing prevalence and burden on healthcare systems. HF is aggravated by type 2 diabetes (T2D) and chronic kidney disease (CKD).

Research Question: Understanding how HF is treated after new diagnosis could improve care.

Aim: Describe treatment of patients with newly diagnosed HF.

Methods: Observational, longitudinal study using electronic medical record data from 24,340 adults (≥18 years) in the US between 2005-2019 with new diagnosis of HF, defined as no HF identified at least 12 months prior to index diagnosis. Outcomes were stratified by HF type (reduced ejection fraction [HFrEF; LVEF ≤40%], preserved ejection fraction [HFpEF; LVEF ≥50%]) and presence of CKD and T2D.

Results: For the 24,340 incident HF cases, mean age was 72.1±13.4 years. 51.1% had HFpEF and 10.0% HFrEF; 38.6% also had CKD, 39.7% had T2D and 40.3% had neither. Most patients were diagnosed in hospital (41.7%), Emergency Department (23.3%) or Primary Care (16.9%). First visit after HF diagnosis was most commonly with Primary Care (34.0%) or other specialties (39.6%), with only 10.7% with a cardiologist, regardless of comorbid CKD or T2D. Within the first year, those with HFpEF vs HFrEF were less likely to be seen by a cardiologist (51.7% vs 79.6%). Hospitalization rates within the first year were higher in patients with HF and both comorbidities (49.6%). All-cause mortality was slightly higher in HFpEF (15.3%) compared to HFrEF (13.9%), particularly in those with HFpEF and CKD (19.2%). At time of diagnosis, patients were likely to use any HF medication. Patients with HFpEF were more likely than those with HFrEF to be treated with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARB; 46.1% vs 40.7%), β-blockers (BB; 53.2% vs 41.3%) and diuretics (41.0% vs 26.5%). Within 90 days of diagnosis, fewer patients with HFpEF vs HFrEF initiated ACEi/ARB (42.8% vs 70.4%), BB (35.4% vs 56.2%) and diuretics (47.8% vs 65.2%).

Conclusion: Primary care plays a major role in early HF care. Comorbid CKD and T2D increased hospitalization and mortality rates but not cardiology care. However, patients with HFpEF were less likely to be seen by a cardiologist or initiate medication following diagnosis vs those with HFrEF.