Year: 2021
Type: article
Abstract: BACKGROUNDHeart failure with reduced ejection fraction has seen remarkable advances with multiple medical therapies that reduce mortality.Despite these breakthroughs, guideline-recommended medical therapy (GDMT) is underutilized.The reasons for suboptimal implementation are manifold but surmountable.These include gaps in clinician knowledge, patient reluctance to take chronic medications, clinical inertia, and, increasingly, GDMT affordability.Since generic carvedilol became available in 2007, patients could be treated with generic and relatively affordable formulations of β-blockers, angiotensin-converting enzyme inhibitors, and mineralocorticoid receptor antagonists.However, with the introduction of angiotensin receptor-neprilysin inhibitor and sodium glucose cotransporter 2 inhibitor therapy, optimal medical therapy now requires the use of 2 brand-name medications.An important driver of suboptimal uptake is their cost-both with regard to barriers to insurance approval and high out-of-pocket costs.This not only hinders therapy uptake, contributing to higher morbidity, but also exacerbates existing disparities because low-income patients are especially affected by these costs.In the following sections, we detail concerns regarding GDMT affordability and provide a path forward.
Source: Circulation
Authors: Alexander T. Sandhu, Paul A. Heidenreich
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Awards: G3246964601, G3449348415, G6462648562
OpenAlex ID: W3136014936