Underuse
What is Underuse?
Underuse occurs when a patient does not receive an evidence-
based service or treatment. In cardiology, underuse often
involves missed drug therapy, office visits, surveillance
testing, procedures, screenings, cardiac rehabilitation and
supportive/palliative care, among other services.
Example of Underuse
A patient newly diagnosed with heart failure is experiencing
frequent fatigue and shortness of breath associated with
decreased pumping function of her heart. It would be considered
underuse if a cardiologist prescribed only dietary and lifestyle
changes without also ordering quadruple-drug GDMT at
maximally tolerated doses. Patients who receive comprehensive
GDMT for heart failure have significantly lower risk of
hospitalization and death due to their disease than those
on a conventional two-drug regimen.
10
How Common is Underuse?
• <25% of patients with heart failure with reduced
ejection fraction get recommended doses of GDMT.
11
• 20% of eligible patients enroll in and complete cardiac
rehabilitation, and just 6.5% get the recommended
36 sessions.
12
• <10% of patients with severe heart failure receive
palliative care.
13
• Only 27% of Medicare beneficiaries hospitalized for
coronary artery disease events, such as heart attack, get
recommended high-dose statins following discharge.
14
• Just 60% of patients with elevated stroke risk associated
with atrial fibrillation receive oral anticoagulants,
as indicated.
15
To root out underuse,
health plans need
a more proactive
approach that
goes beyond UM to
understand where
opportunities
to deliver
evidence-based
care are
being missed.
