Psychosocial factors, guideline-directed medical therapy, and healthcare resource use among patients newly diagnosed with heart failure in the United States

For patients with heart failure with reduced ejection fraction (HFrEF), identifying factors associated with lower uptake of guideline directed medical therapy (GDMT) and higher rates of hospitalizations may inform strategies to improve GDMT implementation. This study assessed the impact of psychosocial and socioeconomic factors on GDMT use and healthcare resource utilization among patients newly diagnosed with HFrEF between 01/01/2017–09/30/2021, in inpatient or outpatient settings across the U.S. Patients were identified from Optum's de-identified Clinformatics® Data Mart Database. GDMT improvement was defined as (1) initiation of ≥2 new GDMT classes among patients on ≤1 class, or (2) addition of ≥1 new GDMT class among patients already on ≥2 GDMT classes, within one month after the initial encounter with a new HFrEF diagnosis (the ‘GDMT improvement period’). Adjusted logistic and negative binomial regressions were used to evaluate associations. The study included 230,664 patients newly diagnosed with HFrEF. For individual GDMTs, utilization rates increased by the end of the GDMT improvement period compared to baseline, but only 12.5% of patients met the definition of GDMT improvement. Psychosocial factors—including depression and substance abuse—were linked to lower odds of GDMT improvement and significantly higher rates of hospitalizations. In contrast, socioeconomic factors like household income and education levels were inversely associated with hospitalization rates but had weaker associations with GDMT improvement. In this US cohort of patients newly diagnosed with HFrEF, there was minimal initiation of GDMT after HFrEF diagnosis. Psychosocial factors were independently associated with lower GDMT uptake and higher risk of hospitalization. • GDMT use remains suboptimal in first month following HFrEF diagnosis in the U.S. • Depression, substance abuse and isolation are associated with lower GDMT improvement • Low household income and education levels are tied to higher hospitalization rates • Targeted interventions are needed for the vulnerable HFrEF patient populations