Ethnic Disparities in Guideline-Directed Medical Therapy for Heart Failure: A Retrospective Cohort Study of Hispanics vs non-Hispanic Patients.

OBJECTIVE

To assess ethnic disparities in 90-day outcomes among patients hospitalized with acute decompensated heart failure (ADHF), and in the use of guideline-directed medical therapy (GDMT) among those with heart failure with reduced ejection fraction (HFrEF).

METHODS

This retrospective cohort study included patients hospitalized with ADHF at a medium-sized health system between January 2018 and May 2024. Primary outcomes were 90-day mortality and readmission. Among patients with HFrEF, GDMT use was assessed as a secondary outcome. Multilevel logistic regression was used to evaluate associations between ethnicity and outcomes.

RESULTS

A total of 14,644 patients with ADHF were included. No significant differences were observed in 90-day mortality (OR 0.69, 95% CI 0.21-2.24, P = 0.540) or 90-day readmission (OR 0.78, 95% CI 0.51-1.19, P = 0.267) between Hispanic and non-Hispanic patients. Among HFrEF patients, Hispanic patients had higher odds of receiving beta blockers (OR 1.32, 95% CI 1.04-1.68, p = 0.023), mineralocorticoid receptor antagonists (OR 1.37, 95% CI 1.05-1.79, p = 0.021), and renin-angiotensin system blockers (OR 1.51, 95% CI 1.17-1.95, p = 0.002). In contrast, no significant difference was observed in the use of sodium-glucose cotransporter-2 inhibitors between the two groups (OR 1.67, 95% CI 0.69-4.05, p = 0.254). Additionally, patients with Medicare (OR 0.65, 95% CI 0.57-0.74, p < 0.001) or unspecified insurance (OR 0.18, 95% CI 0.11-0.28, p < 0.001) had lower odds of receiving GDMT compared to self-pay patients.

CONCLUSION

This study reveals a counterintuitive pattern of higher GDMT use among Hispanic HFrEF patients, underscoring the need to leverage community-based resources and patient assistance programs to address disparities. Further prospective studies are needed to confirm these findings or policy changes to reduce insurance-related barriers to GDMT.