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Disparities in prescriptions among Danish heart failure patients: a national longitudinal cohort study
Maria Klitgaard Christensen1,2, Vibe Bolvig Hyldgård3,4, Christian Madelaire2
1Department of Clinical Research, University of Southern Denmark, Odense, Denmark mklitgaard@health.sdu.dk.
Insights
Disparities exist in prescribing life-saving heart failure medications, angiotensin receptor-neprilysin inhibitors (ARNi) and sodium-glucose co-transporter 2 inhibitors (SGLT2i). Women, older patients, and those living alone or of non-native descent were less likely to receive these crucial treatments.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Angiotensin receptor-neprilysin inhibitors (ARNi) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) are recommended for heart failure management.
- These medications improve symptoms, reduce rehospitalization, and lower mortality rates in heart failure patients.
Purpose of the Study:
- To investigate demographic, geographic, and socioeconomic disparities in ARNi and SGLT2i prescriptions.
- To analyze prescription patterns within a universal healthcare system.
Main Methods:
- Utilized national registers to identify Danish heart failure patients diagnosed after guideline updates.
- Employed Aalen-Johansen estimator and Cox proportional hazard models for analysis of ARNi (n=43,625) and SGLT2i (n=2819) prescriptions.
- Followed patients until prescription redemption, emigration, death, or censoring on June 30, 2022.
Main Results:
- Lack of ARNi and SGLT2i prescriptions was associated with being female, older age, living alone, and non-native Danish background.
- Hazard ratios indicated significantly lower prescription rates for these groups.
- A statistically significant social gradient was observed in ARNi prescriptions, linked to education and income.
Conclusions:
- Significant disparities exist in the prescription of ARNi and SGLT2i for heart failure.
- Lower education, lower income, and specific demographic factors are linked to underprescription of these vital medications.
- Addressing these disparities is crucial for equitable heart failure care.
Background:
Angiotensin receptor-neprilysin inhibitors (ARNi) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) have a Class I indication in the European Society of Cardiology's guidelines for the diagnosis and treatment of acute and chronic heart failure due to benefits in symptom management, rehospitalization rates, and mortality in heart failure. The aim of this study was to investigate demographic, geographic and socioeconomic disparities in prescriptions for ARNi and SGLT2i for heart failure patients in a universal healthcare system.
Methods:
We used national registers to identify all Danish heart failure patients who were diagnosed on or after the updated clinical guidelines by the European Society of Cardiology (14 July 2016 for ARNi and 27 August 2021 for SGLT2i). Patients were followed until redemption of prescription, emigration, death or censoring on 30 June 2022, whichever came first. The Aalen-Johansen estimator and Cox proportional hazard models were used for individual analysis of ARNi (n=43 625) and SGLT2i (n=2819).
Results:
The following factors were associated with lack of prescriptions for ARNi and SGLT2i: being women, older age, living alone and being non-native Danish or descendant. HRs ranged from 0.31 (95% CI 0.28 to 0.36) to 0.86 (95% CI 0.80 to 0.93) for ARNi and 0.49 (95% CI 0.41 to 0.58) to 0.93 (95% CI 0.72 to 1.20) for SGLT2i. Prescriptions for both ARNi and SGLT2i showed a social gradient, with the gradient for ARNi being statistically significant.
Conclusions:
Substantial disparity was found in prescriptions for the potentially life-saving medications, with lack of prescriptions being associated with lower education, lower income and several demographic characteristics.
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