Abstract 18376: Social Vulnerability Indices as a Measure for the Impact of Social Determinants of Health on SGLT2-i Prescriptions in Patients With HFrEF

Introduction: Sodium-glucose cotransporter-2 inhibitors (SGLT2-i) are an important member of the 5 pillars of goal directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF) that was introduced in the 2022 AHA/ACC/HFSA heart failure guidelines. Despite the role of GDMT in reducing cardiovascular mortality and heart failure outcomes, medication accessibility remains limited among more socially vulnerable populations. Social Determinants of Health (SDoH) play a vital role in how patients receive and engage with health care. Goals/Aims: Our study aims to utilize the social vulnerability indices (SVI), an underutilized tool used to quantify social vulnerability, to determine associations between SDoH with SGLT2-i prescriptions.

Methods/Approach: A retrospective review of SVI in 864 patients with a diagnosis of HFrEF in two urban Internal Medicine outpatient clinics between April 2022 and June 2023 was performed. Composite social vulnerability, as well as subgroups of individual data points utilized in the Centers for Disease Control and Prevention SVI were compared between those prescribed and not prescribed a SGLT2-i. Patients with a diagnosis of HFrEF were assigned SVI scores based on geocoded census tract level data. Chi-square analysis was performed to compare groups. A p-value less than <0.05 was considered significant.

Results: A total of 864 patients were evaluated. 78 of these patients were prescribed a SGLT2-i, while 786 were not prescribed a SGLT2-i. Those with a SVI overall percentile of 74-100% (less social vulnerability) were significantly more likely to be on a SGLT2-i (19.23% vs 10.02%, p = 0.022). Descriptively, patients with SVI Est <24% below poverty were less often prescribed SGLT2-i (92.05% vs 7.95%). Similarly, those without a vehicle as defined by SVI Est <24% households with no vehicle available were on less frequently prescribed SGLT2-i (93.24% vs 6.76%).

Conclusion: Use of SVI data may help identify barriers to SGLT-2 prescribing in patients with HFrEF when analyzed on a population level. Further studies and investigations to target these barriers may be beneficial in increasing the amount of patients on indicated GDMT.

Keywords: social determinants of health, SGLT-2i, GDMT, HFrEF