Abstract 4343216: Guideline-Directed Medical Therapy and Clinical Outcomes in African American Women with Congestive Heart Failure from Low- to Medium-Income Backgrounds at a Safety Net Hospital

Background: Heart failure among African American women represents a significant public health challenge. The high prevalence of comorbidities often necessitates selective implementation of guideline-directed medical therapy (GDMT). This study examines which medication classes should be prioritized in this vulnerable population. Methods: We conducted a retrospective study of 283 African American women with heart failure admitted to Cape Fear Valley Medical Center, a safety-net hospital serving low-income patients in North Carolina (2021-2022). We analyzed relationships between GDMT regimens and clinical outcomes. Results: Among patients, 50% experienced 30-day readmission, 57% 90-day readmission, and 23% died within 1 year. Medication utilization was suboptimal: 10% received goal doses of RAS inhibitors, 13% goal doses of beta blockers, 4% medium/goal doses of mineralocorticoid receptor antagonists (MRAs), and 11% SGLT2 inhibitors. Mean GDMT composite was 2.4±1.8, with only 8% achieving composite ≥5. Each one-point increase in GDMT composite reduced 30-day (OR=0.85, p=0.02) and 90-day readmission risk (OR=0.86, p=0.03). Higher GDMT composite was associated with decreased mortality in unadjusted analysis (OR=0.86, p=0.07). Concurrent optimization of RAS inhibitors and beta blockers reduced readmission risk (OR=0.70, p=0.04). Low-dose MRA lowered 30-day readmission (OR=0.27, p<0.01). Medium-dose beta blockers reduced 1-year mortality (OR=0.13, p=0.03), as did medium doses of MRA (OR<0.01, p<0.01). Conclusions: Strategic prioritization of specific GDMT components improves outcomes in this population with multiple comorbidities. Each one-point increase in GDMT composite was associated with 15% reduced readmission risk. Beta blockers should be prioritized for mortality reduction, MRAs for both mortality and readmission reduction, and RAS inhibitors with beta blockers for reducing readmissions.