(1021) Eligibility of Mineralocorticoid Receptor Antagonists for Hfref Patients in an Outpatient Family Care Practice Setting

Objectives: One of the leading causes of both morbidity and mortality in the US is heart failure. Approximately 6.7 million adults in the US suffer from heart failure with 46% heart failure with reduced ejection fraction (HFrEF). Pharmacological therapy advances have led to clinical guideline updates with several drug classes that significantly improve morbidity and mortality, known collectively as guideline-directed medical therapy (GDMT). Despite strong guideline recommendations, GDMT prescribing remain inadequate in HFrEF patients. There are significant gaps between best practice and current practice in the diagnosis, treatment, and management of heart failure. Mineralocorticoid antagonists (MRA) have been shown to reduce the risk of all-cause mortality and HF hospitalization, and are considered to be more affordable compared to the newer agents. However, available research demonstrates their underutilization in patients with HFrEF. This presents an opportunity for primary care providers to work collaboratively with cardiologists and clinical pharmacists to utilize GDMT and frequent monitoring for HFrEF patients. The primary objective of this study is to determine how many patients with a diagnosis of HFrEF are currently prescribed a MRA along with other HFrEF guideline-directed medication classes.

Methods: This study will be a retrospective chart review that characterizes current GDMT utilization for HFrEF patients in an outpatient primary care clinic. The chart review will be conducted in Winchester, Virginia. Athenanet electronic health record (EHR) will be used to collect the data to identify eligible patients for inclusion. Patients will be eligible for this study if they were seen by their primary care provider between the dates of January 1st, 2020 to September 30th, 2023 with a HFrEF diagnosis (a left ventricular ejection fraction (LVEF) of < 40%). Patients will be excluded if they are under 18 years of age or pregnant. The primary endpoint of this study is to determine the number of patients with LVEF < 40% that are currently prescribed a MRA as part of GDMT. Secondary endpoints will determine the number of these patients prescribed other GDMT classes including renin-angiotensin system (RAAS) inhibitors (angiotensin-converting enzyme inhibitors (ACE-i), angiotensin receptor blockers (ARB) or angiotensin receptor-neprilysin inhibitors (ARNI)), beta blockers (BB), and sodium-glucose co-transporter 2 inhibitors (SGLT2-i). Other endpoints will determine whether adverse drug reactions or contraindications are present that might prevent initiation of GDMT. Data will be descriptive in nature and presented in aggregate as means and percentages upon project completion. This study was approved by Shenandoah University’s Institutional Review Board.

Results: Research in Progress.

Conclusions: Research in Progress.