Virginia Via Research Day Book 2026

Medical Student Research Clinical

20

BARRIERS BEYOND INCOME: MEDICATION AFFORDABILITY AND SGLT2 INHIBITOR USE IN HFpEF

Justin Luy, OMS-III; Daniel Reuss, OMS-III; Jake Zelie, OMS-III; Leona Jafari, OMS-III; Abigail Mistretta, DO; Ramu Anandakrishnan, PhD Corresponding author: jluy@vcom.edu, dreuss@vcom.edu, belie@vcom.edu

VCOM-Virginia, Blacksburg, Virginia

Background: Heart failure is a common disease that affects approximately 1-3% of the population and remains a major cause of morbidity and mortality in the United States. While there are many different etiologies, it ultimately occurs when the heart is unable to pump enough blood to meet the body's needs. Heart failure with preserved ejection fraction (HFpEF), defined by an ejection fraction greater than 50%, is characterized by impaired ventricular relaxation and elevated filling pressures. Sodium-glucose cotransporter-2 (SGLT 2) inhibitors are a cornerstone of guideline-directed medical therapy (GDMT) for HFpEF. Their high cost may limit access for some patients. Socioeconomic factors, like income and race, play a significant role in shaping health outcomes. These non-medical factors can significantly impact patient health outcomes, yet are often overlooked in clinical decision-making and disease management. Objective: To evaluate the association between income level, medication affordability, and race with SGLT2 inhibitor use among patients with HFpEF.

Methods: We conducted a cross-sectional analysis using data obtained from the All of Us database. Patients with HFpEF were categorized based on SGLT2 inhibitor use. Income level (<$50,000 vs ≥$50,000 annually) and self-reported inability to afford prescription medications in the prior 12 months were analyzed in relation to SGLT2 inhibitor use using chi-square testing. Racial and ethnic distributions were described among HFpEF patients with and without SGLT2 inhibitor therapy who completed demographic surveys. Results: Among patients with HFpEF, there was no significant association between income level and SGLT2 inhibitor use (χ² = 0.08, p = 0.77). In contrast, patients reporting difficulty affording prescription medications demonstrated a trend toward lower SGLT2 inhibitor use compared with those without affordability concerns (χ² = 3.74, p = 0.053). No significant racial and ethnic differences were observed in the distribution of SGLT2 inhibitor use.

Conclusion: In this national cohort of patients with HFpEF, income level alone was not associated with the use of SGLT2 inhibitors. However, self reported medication affordability was associated with a trend toward reduced utilization of SGLT2 inhibitors, suggesting that cost-related barriers beyond income may influence access to GDMT. Despite no significant difference observed, racial and ethnic differences in SGLT2 inhibitor use warrant further investigation. These findings highlight the importance of addressing medication affordability and equity when optimizing HFpEF management.

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191 2026 Research Recognition Day