Association between Education Attainment and Guideline-Directed Medication Therapy in Patients with Heart Failure and Reduced Ejection Fraction

Objective: The aim of the current study was to evaluate association of education attainment and guideline-directed medications therapy (GDMT) in patients with heart failure and reduced ejection fraction (HFrEF). Method: HFrEF patients were enrolled, and baseline characteristics were recorded. Based on highest educational attainment, patients were divided into low and high education attainment groups. Data on GDMT use at admission, discharge and follow-up were collected and between-group differences were evaluated. Results: A total of 336 patients were recruited, and 59.8% (n = 201) were defined as low education attainment. Patients with low education attainment were older and more likely to be female, obese and smokers. In addition, they had a higher prevalence of hypertension and valvular heart disease. Patients with low education attainment also had lower physical and mental component scores (PCS, 50.5 +/- 6.4 vs. 56.3 +/- 7.8), (MSC, 48.4 +/- 6.0 vs. 54.7 +/- 5.6) but higher serum NT-proBNP levels (1148.6 +/- 233.4 vs. 1050.8 +/- 205.6 pg/mL). Significant differences in GDMT use at admission, discharge and follow-up were observed. In the unadjusted model, high education attainment was associated with 2-fold odds of GDMT use at discharge. With adjustment for covariates, the high education attainment group remained significantly associated with being 22% more likely to receive GMDT at discharge. Similar findings were observed in associations between high education attainment and GDMT use at follow-up. After adjustment for PCS and MCS, high education attainment was still significantly associated with GDMT use at follow-up, with odds ratio of 1.13 and a 95% confidence interval of 1.08-1.28. Conclusion: HFrEF patients are under-treated. Education attainment is significantly associated with GDMT use at discharge and follow-up.