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Abstract: TH-PO602

Newer Guideline-Directed Medical Therapies Are Underutilized in 2021-2022 in Patients With Heart Failure and CKD

Session Information

Category: Hypertension and CVD

  • 1501 Hypertension and CVD: Epidemiology‚ Risk Factors‚ and Prevention


  • Canonico, Mario Enrico, CPC Clinical Research, Aurora, Colorado, United States
  • Hsia, Judith, University of Colorado Denver School of Medicine, Aurora, Colorado, United States
  • Cannon, Christopher Paul, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Bonaca, Marc P., CPC Clinical Research, Aurora, Colorado, United States

Chronic kidney disease (CKD) is a common comorbidity in patients with heart failure (HF). In 2021 and 2022, HF guidelines endorsed newer therapies such as angiotensin receptor-neprilysin inhibitors (ARNI) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) as first-line medications to improve clinical outcomes in HF patients with or without CKD.


Patients with HF encounters from May 2021 to April 2022 were extracted from the University of Colorado health system TriNetX database. Use of guideline-directed medical therapy (GDMT) was compared by chi square and p for trend calculated across CKD stages. CKD stages were defined by eGFR; dialysis patients were excluded.


Among 17990 patients with HF encounters, 51% had reduced (HFrEF) and 49% preserved ejection fraction (HFpEF). Mild CKD was more common among patients with HFrEF than HFpEF (Stage G1 25% vs 20%, p<0.0001; G2 40% vs 38%, p<0.05) while more severe CKD was more common in patients with HFpEF (G3 32% vs 37%, p<0.0001; G4 4% vs 5%, p=0.0005). Prevalence of hypertension, diabetes (DM), hyperlipidemia, prior myocardial infarction and peripheral artery disease increased with CKD stage (all p <0.0001). Older GDMT (B-blockers, ACE inhibitors, ARB) were widely prescribed (Figure). Use of mineralocorticoid receptor antagonists was intermediate, whereas use of newer GDMT (ARNI and SGLT2i) was less frequent. Among patients with HFrEF or HFpEF, those with DM were more likely to receive SGLT2i than those without T2D (p<0.0001 for each CKD stage).


ARNI and SGLT2i use even in 2021-2 was infrequent among patients with HF irrespective of CKD stage; SGLT2i use was particularly low in those without DM.

Use of GDMT in HFrEF (upper panel) and in HFpEF (lower panel) by CKD stage.


  • Commercial Support – Lexicon Pharmaceuticals, The Woodlands, TX, USA