Disparities in access to new pharmaceuticals among Danish heart failure patients: a national longitudinal cohort study

Background and Aim<br/>The European Society of Heart Failure gave angiotensin receptor neprilysin inhibitor (ARNi) and sodium-glucose co-transporter 2 inhibitors (SGLT2i) a class I indication from 2016 and 2021, respectively. However, the inclusion of a specific course of treatment in clinical guidelines does not ensure patients’ access, which relies on multiple factors such as physician and patient awareness, health issuance and prescription fulfillment. Previous studies have found that demographic factors, socioeconomic status and geographic location are associated with disparities in access to other types of heart failure pharmacological treatments, challenging the principle of equitable access based on need within the Danish healthcare system. The aim of this study was to investigate demographic, geographic and socioeconomic disparities in access to ARNi and SGLT2i for heart failure patients in the Danish national healthcare system.<br/><br/>Design and Methods<br/>The study was an observational longitudinal cohort study based on Danish national registers, and the study period was from July 14th 2016 to June 30th 2022. We investigated disparities in medication access using cumulative incidence functions based on the Aalen-Johansen estimator and Cox proportional hazard models.<br/><br/>Primary variables Sex, age, living status, national origin, regional residence, education and family income.<br/><br/>Preliminary results<br/>After adjustment for patients’ baseline characteristics and comorbidities, we found a lower access to ARNi and SGLT2i among females, patients aged 80 and above, non-native Danish, lower education group, low family income, patients living alone and patients residing outside the Capital Region of Denmark compared with the reference levels.<br/><br/>Conclusion<br/>We found unwarranted disparities in access to ARNi and SGLT2i for a wide range of demographic, geographic and socioeconomic characteristics.