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Geographic Variation in the Quality of Heart Failure Care Among U.S. Veterans

Revanth S Kosaraju1, Gregg C Fonarow2, Michael K Ong3

  • 1Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. Electronic address: https://twitter.com/revanthsk12.

JACC. Heart Failure
|August 5, 2023
PubMed

Insights

Geographic variations in heart failure with reduced ejection fraction (HFrEF) care exist. Targeted strategies are needed to improve guideline-directed medical therapies (GDMT) prescription in underserved regions.

Area of Science:

  • Cardiology
  • Health Services Research
  • Public Health

Background:

  • The prevalence of heart failure (HF) is increasing globally.
  • Guideline-directed medical therapies (GDMT) are proven to reduce adverse outcomes in patients with heart failure with reduced ejection fraction (HFrEF).
  • Geographic variations in the quality of HFrEF care are not well understood.

Purpose of the Study:

  • To evaluate national variations in the prescription of GDMT for HFrEF within the Veterans Health Administration (VHA).
  • To identify potential associations between geographic disparities in GDMT prescription and socioeconomic factors.

Main Methods:

  • A cohort of US Veterans with HFrEF was identified.
  • Patient addresses were linked to hospital referral regions (HRRs).
  • GDMT prescription data were analyzed from July 2020 to July 2021. Composite GDMT scores and prescription rates within HRRs were calculated. Geographic variation was visualized using choropleth maps, and associations with demographic factors were assessed via linear regression.

Main Results:

  • Significant geographic variation in GDMT prescription rates and composite scores was observed across HRRs.
  • Prescription rates varied by medication class, with beta-blockers being the most prescribed (80%) and angiotensin receptor-neprilysin inhibitors the least (12.2%).
  • Lower GDMT performance was associated with higher income inequality (Gini coefficient) and a greater percentage of low-income residents within HRRs.

Conclusions:

  • Substantial geographic disparities in HFrEF care quality, specifically GDMT prescription, are evident within the VHA.
  • Targeted interventions are necessary to improve GDMT uptake in lower-performing regions, particularly those facing socioeconomic challenges like poverty and income inequality.
Abstract

Keywords:
Veterans Affairsdifferencesguideline-directed medical therapiesheart failuremapnational

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