Abstract P194: Polypill Eligibility For Patients With Heart Failure With Reduced Ejection Fraction In South India: A Secondary Analysis Of A Prospective, Interrupted Time Series Study
Authors: Vijay Aishwarya , Mohanan Padinhare P , Kondal Dimple , Baldridge Abigail S , Davies Divin , Devarajan Raji , Unni Govindan , Abdullakutty Jabir , natesan syam , Joseph Johny , Jayagopal Pathiyil B , Joseph Stigi , Gopinath Rajesh , Prabhakaran Dorairaj , Huffman Mark D , Agarwal Anubha 
Published: April 2022

In India, data from large HF registries has demonstrated significantly lower 5-year mortality rates for patients with HFrEF discharged on guideline-directed medical therapy (GDMT), revealing an important target for intervention to improve clinical outcomes. Hospital-based quality improvement initiatives to increase rates of GDMT at hospital discharge have had limited effect, suggesting additional strategies are needed to improve GDMT rates in HFrEF patients. Polypills for HFrEF have been proposed as an implementation strategy to simplify the current treatment paradigm for undertreated patients with HFrEF. However, the potential effect of HFrEF polypills on increasing GDMT rates in target populations is unknown. The objective of this secondary analysis is to describe eligibility for a potential HFrEF polypill in the context of GDMT prescription rates for South Indian patients with HFrEF. We analyzed data from a prospective, interrupted time series study in 2018 (HFQUIK) that evaluated the effect of a quality improvement intervention on process of care measures and clinical outcomes in patients hospitalized with acute HFrEF in 8 hospitals in South India. The primary outcome was prescription of GDMT defined as an ACE-I or ARB or ARNi, along with a beta-blocker and aldosterone antagonist. Participants were eligible for a HFrEF polypill containing GDMT if LVEF<40%, HR ≥50 beats/min, creatinine ≤2.5 mg/dL in men and ≤2 mg/dL in women, and potassium <5 mEq/L. We included 937 participants with HFrEF (n = 494 control period, n = 443 intervention period). Prescription rates of ACE-I or ARB or ARNi, beta-blocker, and aldosterone antagonists were low on hospital admission and increased at hospital discharge. The prescription of GDMT increased from 5.5% (27/494) to 28.8% (127/494) in the control period and from 4.5% (20/443) to 42.3% (171/443) in the intervention period. Notably, more than 80% of participants were eligible for a HFrEF polypill at hospital discharge during both control (364/494) and intervention (336/443) periods, with similar rates among female and male participants. In this study, than 80% of patients were eligible for a HFrEF polypill at discharge. Although the HF QUIK quality improvement intervention increased rates of GDMT at hospital discharge, routine administration of a HFrEF polypill could further increase this rate and improve adherence by 44% (95% CI: 26% to 65%) in a population that remains undertreated despite targeted quality improvement interventions. Availability of multiple HFrEF polypill doses could prioritize safety and tolerability with low-dose initiation and subsequent titration to higher-dose polypills. This analysis suggests a simplified polypill-based management strategy could be transformative for closing the treatment gap in HFrEF inequities in India and globally.