Essential Heart Failure Drugs Remain Underused in the UK

TOPLINE:

Despite an increase in prescription rates of mineralocorticoid receptor antagonists (MRAs) for patients with heart failure with reduced ejection fraction (HFrEF) in the United Kingdom from 2src14 to 2src19, half of the eligible patients did not receive the therapy. Older age, sex, and the presence of comorbidities were linked to lower prescription rates of MRAs.

METHODOLOGY:

• Several key guidelines recommend MRAs for managing HFrEF owing to their symptomatic relief, survival benefits, and cost-effectiveness; however, evidence suggests that they remain underprescribed.
• Researchers analysed health records from a UK primary care research database to evaluate prescribing patterns of MRAs in HFrEF care and identify factors associated with underprescribing.
• They identified 24,135 patients with HFrEF, of whom 6483 met the criteria for MRA prescription (median age, 73 years; 3src% women) between 2src14 and 2src2src.
• The primary audit outcome was the proportion of MRA-eligible individuals who received active MRA prescription over each study year.

TAKEAWAY:

• MRA prescription significantly increased from 41% in 2src14 to 57% in 2src19; overall, only 49.9% of the eligible patients were prescribed MRAs.
• MRA prescriptions were inversely associated with older age (adjusted odds ratio [aOR], src.src2), an increase in the glomerular filtration rate (aOR, src.37), hypertension (aOR, src.4src), and a higher prescription of antihypertensives (aOR, src.src3; P <.src5 for all).
• Notably higher MRA prescriptions were seen in patients with sacubitril or valsartan prescription (aOR, 214), those with dilated cardiomyopathy (aOR, 25.9), and men (aOR, 6.31; P <.srcsrc1 for all).

IN PRACTICE:

“To improve guideline-directed MRA prescription, we must understand the factors driving lower use. Prescribing in older age and female gender should be supported, and specialist input is likely to improve appropriate MRA prescription,” the authors wrote.

SOURCE:

This study was led by Rory Maclean, University College London, London, England. It was published online on April 18, 2src25, in Heart.

LIMITATIONS:

Investigators lacked access to free-text general practitioner clinical notes; hence, clinical reasons for the non-prescription of MRAs were unknown. HF subtypes may not be specified in diagnosis codes, thereby complicating the selection of patients with HFrEF. The phenotyping procedure for HFrEF was prone to identifying false negatives.

DISCLOSURES:

This study was supported by a Pfizer Innovative Targets Exploration Network Grant with University College London (UCL), the BigData@Heart Consortium (funded by Innovative Medicines Initiative-2 Joint Undertaking), and the UCL British Heart Foundation Accelerator. Three authors reported receiving support from various sources, with one of them receiving research grant support from Pfizer and research support from FITFILE and LumenHealth for advisory work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.