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Comparative Study
. 2024 May 11;24(1):247.
doi: 10.1186/s12872-024-03911-1.

Differences in provider approach to initiating and titrating guideline directed medical therapy in heart failure with reduced ejection fraction

David J Cordwin  1 , Jessica Guidi  2   3 , Lana Alhashimi  1 , Scott L Hummel  2   3   4 , Todd M Koelling  2   3 , Michael P Dorsch  5   6
Affiliations
Comparative Study

Differences in provider approach to initiating and titrating guideline directed medical therapy in heart failure with reduced ejection fraction

David J Cordwin et al. BMC Cardiovasc Disord. .

Abstract

Background: Despite the strong evidence supporting guideline-directed medical therapy (GDMT) in patients with heart failure with reduced ejection fraction (HFrEF), prescription rates in clinical practice are still lacking.

Methods: A survey containing 20 clinical vignettes of patients with HFrEF was answered by a national sample of 127 cardiologists and 68 internal/family medicine physicians. Each vignette had 4-5 options for adjusting GDMT and the option to make no medication changes. Survey respondents could only select one option. For analysis, responses were dichotomized to the answer of interest.

Results: Cardiologists were more likely to make GDMT changes than general medicine physicians (91.8% vs. 82.0%; OR 1.84 [1.07-3.19]; p = 0.020). Cardiologists were more likely to initiate beta-blockers (46.3% vs. 32.0%; OR 2.38 [1.18-4.81], p = 0.016), angiotensin receptor blocker/neprilysin inhibitor (ARNI) (63.8% vs. 48.1%; OR 1.76 [1.01-3.09], p = 0.047), and hydralazine and isosorbide dinitrate (HYD/ISDN) (38.2% vs. 23.7%; OR 2.47 [1.48-4.12], p < 0.001) compared to general medicine physicians. No differences were found in initiating angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEi/ARBs), initiating mineralocorticoid receptor antagonist (MRA), sodium-glucose transporter protein 2 (SGLT2) inhibitors, digoxin, or ivabradine.

Conclusions: Our results demonstrate cardiologists were more likely to adjust GDMT than general medicine physicians. Future focus on improving GDMT prescribing should target providers other than cardiologists to improve care in patients with HFrEF.

Keywords: Evidence-based therapy; Guideline-directed medical therapy (GDMT); Heart failure with reduced ejection fraction (HFrEF); Medications.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Odds ratios for initiating and titrating GDMT based on provider type. The odds ratio of initiating or titrating GDMT for cardiologists compared to general medicine physicians, controlling for baseline differences between the two groups. The diamond points represent the odds ratio and the lines represent the 95% confidence interval. Abbreviations as listed in Abbreviations List
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