Abstract 102: Racial, Gender, and Socioeconomic Differences in Sacubitril-valsartan and Ivabradine Utilization for the Management of Heart Failure With Reduced Ejection Fraction in The United States

Background: Current guidelines for heart failure with reduced ejection fraction (HFrEF) recommend transition to an angiotensin receptor-neprilysin inhibitor (ARNI) from an angiotensin-converting enzyme inhibitor (ACE) or angiotensin receptor blocker (ARB), and addition of ivabradine in select patients because of the proven clinical benefit of these therapies. Inequitable care delivery based on race, gender, and socioeconomic status has been demonstrated in other settings. In this study, we assessed the association of race, gender, and socioeconomic status with ARNI and ivabradine utilization among commercially-insured HFrEF patients.

Methods: We performed a retrospective cohort analysis of adult patients with diagnosis of HFrEF based on ICD 10 codes between October 2015 and December 2018 using OptumInsight’s Clinformatics Data Mart. HFrEF patients were considered eligible for ARNI analysis or ivabradine analysis if they had a prescription for ACE/ARB or beta-blocker, respectively, within 12 months of the study period. We performed a multivariable logistic regression, adjusting for age, sex, race/ethnicity, region, median zip code-linked household income, and clinical covariates to identify factors associated with the incident use of ARNI and ivabradine.

Results: Of 112, 068 patients who met inclusion criteria in the ARNI analysis, 8,747 (7.8%) were prescribed an ARNI during the study period. Only 385 (0.3%) patients of 128,997 who met inclusion criteria were prescribed ivabradine during the study period. In multivariable analyses, black and Latinx patients were more likely to receive an ARNI compared with white patients (OR 1.16; 95% CI, 01.08-1.24; P=<0.0001 for black, OR 1.21; 95% CI 1.11-1.32;P<0.0001 for Latinx). Female gender was independently associated with lower odds of ARNI prescription (OR 0.70; 95% CI 0.67-0.74; p<0.0001). Patients with household income greater than $100,000 or $50,000-99,999 were more likely to be prescribed an ARNI than those with income less than $50,000 (OR 1.35, 95% CI 1.26-1.46; p<0.0001 and OR 1.19; 95% CI 1.13-1.26; p<0.0001 respectively). Race, socioeconomic status, and gender were not independently associated with ivabradine prescription.

Conclusion: There have been relatively low rates of ARNI and ivabradine utilization among privately insured HFrEF patients. Female gender and lower socioeconomic status were independently associated with lower rates of ARNI utilization, but racial and ethnic minorities had higher ARNI use rates than whites.