Background: Current guidelines for heart failure with reduced ejection fraction (HFrEF) recommend transition to an angiotensin receptor-neprilysin inhibitor (ARNI) from an angiotensin-converting enzyme inhibitor (ACE) or angiotensin receptor blocker (ARB), and addition of ivabradine in select patients because of the proven clinical benefit of these therapies. Inequitable care delivery based on race, gender, and socioeconomic status has been demonstrated in other settings. In this study, we assessed the association of race, gender, and socioeconomic status with ARNI and ivabradine utilization among commercially-insured HFrEF patients. Methods: We performed a retrospective cohort analysis of adult patients with diagnosis of HFrEF based on ICD 10 codes between October 2015 and December 2018 using OptumInsight’s Clinformatics Data Mart. HFrEF patients were considered eligible for ARNI analysis or ivabradine analysis if they had a prescription for ACE/ARB or beta-blocker, respectively, within 12 months of the study period. We performed a multivariable logistic regression, adjusting for age, sex, race/ethnicity, region, median zip code-linked household income, and clinical covariates to identify factors associated with the incident use of ARNI and ivabradine. Results: Of 112, 068 patients who met inclusion criteria in the ARNI analysis, 8,747 (7.8%) were prescribed an ARNI during the study period. Only 385 (0.3%) patients of 128,997 who met inclusion criteria were prescribed ivabradine during the study period. In multivariable analyses, black and Latinx patients were more likely to receive an ARNI compared with white patients (OR 1.16; 95% CI, 01.08-1.24; P =<0.0001 for black, OR 1.21; 95% CI 1.11-1.32;P<0.0001 for Latinx). Female gender was independently associated with lower odds of ARNI prescription (OR 0.70; 95% CI 0.67-0.74; p<0.0001). Patients with household income greater than $100,000 or $50,000-99,999 were more likely to be prescribed an ARNI than those with income less than $50,000 (OR 1.35, 95% CI 1.26-1.46; p<0.0001 and OR 1.19; 95% CI 1.13-1.26; p<0.0001 respectively). Race, socioeconomic status, and gender were not independently associated with ivabradine prescription. Conclusion: There have been relatively low rates of ARNI and ivabradine utilization among privately insured HFrEF patients. Female gender and lower socioeconomic status were independently associated with lower rates of ARNI utilization, but racial and ethnic minorities had higher ARNI use rates than whites.
Objective. By integrating meta-analysis and network pharmacology strategy, the clinical efficacy of Zhishe Tongluo capsule in the treatment of cerebral infarction was evaluated, and the intervention mechanism was preliminary explored. Methods. Through meta-analysis, the Chinese and English literature of the randomized controlled trial (RCT) of Zhishe Tongluo capsule in the treatment of cerebral infarction was comprehensively searched. Based on the standard of Na Pai, the quantitative literature was determined and the Review Manager data were statistically analyzed. Results. A total of 10 RCTs literatures were included. These literatures included a total of 1278 subjects, of which 670 were in the treatment group and 608 were in the control group. In terms of indicators of efficiency and adverse reaction rate, the treatment group was better than the control group. There was a statistical difference P < 0.05 ; a total of 559 chemical constituents and 2306 potential targets were obtained from the online database. Of these, 201 components, 145 targets, and 185 pathways were closely related to cerebral infarction. Conclusions. The available evidence indicates that the addition of Zhishe Tongluo capsule to the conventional treatment of Western medicine can improve the clinical efficacy of cerebral infarction and has some advantages in regulating blood lipids and hemorheology, but the overall evidence level is low, which still needs to be further supported by large-scale and multicenter RCTs; intervention of brain infarction by Zhishe Tongluo capsule is a comprehensive result of multicomponent and multi-target interactions. On the basis of the combined meta-analysis and network pharmacology in scientific attempts, it also provides a reference for the clinical evaluation of other drugs and mechanism research.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.