(P120) TIME TO GUIDELINE-DETERMINED MEDICAL THERAPY IN PATIENTS WITH DE NOVO HEART FAILURE: A RETROSPECTIVE POPULATION-BASED STUDY FROM ALBERTA, CANADA

Background: Quadruple therapy is recommended for the management of patients with heart failure (HF) and reduced ejection fraction (HFrEF), however, many patients in Canada are not yet on triple therapy. In order to provide background and identify barriers to quadruple therapy, in this study, the aim was to explore the time to initiate triple therapy in a population-based cohort of patients with de novo HF.

METHODS AND RESULTS: Adult patients with de novo hospital or emergency department diagnosis of HF between April 1, 2008, and March 31, 2018, in Alberta, Canada were included, and linked to echocardiography data to identify patients with HFrEF (EF < 40%). Any treatment with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists was captured if prescribed for ≥28 days and filled at least once during the 12 months after the index episode. Patients with no-, mono-, dual-, and triple-therapy were identified. Time to therapy was calculated from zero to 480 days, and outcomes were tracked up to March 31, 2020. Among the 29,103 patients with HF, 15.6%, 44.2%, 32.2%, and 8.0% received, respectively, no therapy, monotherapy, dual therapy, and triple therapy for HF within 1-year after the index episode. Among patients with HF, 54.9% were HFrEF. In the HFrEF cohort, 9.5%, 27.5%, 41.6%, and 21.4% received no therapy, monotherapy, dual therapy, and triple therapy, respectively during 1-year after the index episode. The time to mono-, dual- and triple-therapy in patients with HFrEF were a mean of 22.6 ± 47.7, 29.1 ± 45.3, and 32.1 ± 44.6 days, respectively, among those who received these therapies. Patients who received triple therapy were younger, more likely to be male, with a lower frequency of renal impairment, or chronic obstructive pulmonary diseases, but a higher frequency of coronary artery disease, and lower baseline natriuretic peptide, glomerular filtration rate, and left ventricular ejection fraction levels compared to their counterparts. Patients with triple therapy had lower rates of clinical outcomes compared to those on no-, mono- or dual-therapy (Table).

Conclusion: Despite guideline recommendations, triple therapy is underutilized in patients with HFrEF and delay in starting therapy remains a barrier. Innovative interventions are required to address this clinical practice gap for patients with HFrEF.