Treatment Patterns, Outcomes, and Persistence to Newly Started Heart Failure Medications in Patients with Worsening Heart Failure: A Cohort Study from the United States and Germany

IF 2.8 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

American Journal of Cardiovascular Drugs Pub Date : 2024-04-04 DOI:10.1007/s40256-024-00643-7

Alexander Michel, Coralie Lecomte, Christoph Ohlmeier, Hanaya Raad, Frederike Basedow, Dennis Haeckl, Dominik Beier, Thomas Evers

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引用次数: 0

Abstract

Background

Data are limited regarding guideline-directed medical therapy (GDMT) treatment patterns in patients with worsening heart failure (HF).

Methods

We used administrative claims databases in Germany and the USA to conduct a retrospective cohort study of patients with worsening HF. Two cohorts of patients with prevalent HF and a HF hospitalization (HFH) from 2016 to 2019, alive at discharge (N = 75,140 USA; N = 47,003 Germany) were identified. Index date was the first HFH during the study period. One-year HF rehospitalization and mortality rates were calculated and a composite endpoint of both outcomes assessed using Kaplan–Meier estimation. We evaluated HF medication patterns in the 6 months before and after the index date. New users of a HF medication (at discharge/after index HFH) were followed for 1 year to evaluate persistence (no treatment gaps > 2 months)

Results

One-year HF rehospitalization rates were 36.2% (USA) and 47.7% (Germany). One year mortality rates were 30.0% (USA) and 23.0% (Germany), and the composite endpoint (mortality/HF rehospitalization) was reached in 55.1 % (USA) and 56.6% (Germany). Kaplan–Meier plots showed the risk for the composite endpoint was high in the early post discharge period. Comparison of patterns pre- and postindex HFH showed some increase in use of mineralocorticoid receptor antagonists (MRAs), angiotensin receptor–neprilysin inhibitor (ARNI), and triple therapy; use of angiotensin-converting enzyme (ACE) inhibitor/ angiotensin receptor blocker (ARB) plus beta-blockers remained constant/slightly declined; < 20% patients received triple therapy (ACE inhibitor/ARB plus beta-blocker plus MRA). A third of patients were new users; 1 year persistence rates were often low.

Conclusions

Morbidity, mortality, and rehospitalization risk is high among patients with worsening HF; uptake and continuation of GDMT is suboptimal.

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心力衰竭恶化患者的治疗模式、疗效以及对新开始使用的心力衰竭药物的耐受性：来自美国和德国的队列研究

摘要背景有关心力衰竭（HF）恶化患者的指导性医疗疗法（GDMT）治疗模式的数据十分有限。方法我们利用德国和美国的行政报销数据库，对心衰恶化患者进行了一项回顾性队列研究。我们确定了 2016 年至 2019 年期间患有流行性高血压和高血压住院（HFH）、出院时存活的两组患者（N = 75,140 美国；N = 47,003 德国）。索引日期为研究期间的首次高频住院。我们计算了一年的高血压再住院率和死亡率，并使用卡普兰-梅耶估计法评估了这两种结果的复合终点。我们评估了指数日期前后 6 个月的高血压用药模式。对高血压药物的新使用者（出院时/高血压指数之后）进行为期 1 年的随访，以评估其持续性（无治疗间隙 > 2 个月）结果一年的高血压再住院率为 36.2%（美国）和 47.7%（德国）。一年死亡率为 30.0%（美国）和 23.0%（德国），达到综合终点（死亡率/高频再住院）的比例分别为 55.1%（美国）和 56.6%（德国）。Kaplan-Meier 图显示，出院后早期出现综合终点的风险较高。对指数HFH前后的模式进行比较后发现，矿物皮质激素受体拮抗剂（MRA）、血管紧张素受体-奈普利蛋白抑制剂（ARNI）和三联疗法的使用有所增加；血管紧张素转换酶（ACE）抑制剂/血管紧张素受体阻滞剂（ARB）加β-受体阻滞剂的使用保持不变/略有下降；20%的患者接受了三联疗法（ACE抑制剂/ARB加β-受体阻滞剂加MRA）。三分之一的患者是新用药者；1 年的坚持率通常很低。结论高血压恶化患者的发病率、死亡率和再住院风险很高；GDMT 的接受率和持续率都不理想。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American Journal of Cardiovascular Drugs 医学-心血管系统

CiteScore

6.70

自引率

3.30%

发文量

审稿时长

>12 weeks

期刊介绍： Promoting rational therapy within the discipline of cardiology, the American Journal of Cardiovascular Drugs covers all aspects of the treatment of cardiovascular disorders, particularly the place in therapy of newer and established agents. Via a program of reviews and original clinical research articles, the journal addresses major issues relating to treatment of these disorders, including the pharmacology, efficacy and adverse effects of the major classes of drugs; information on newly developed drugs and drug classes; the therapeutic implications of latest research into the aetiology of cardiovascular disorders; and the practical management of specific clinical situations. The American Journal of Cardiovascular Drugs offers a range of additional enhanced features designed to increase the visibility, readership and educational value of the journal’s content. Each article is accompanied by a Key Points summary, giving a time-efficient overview of the content to a wide readership. Articles may be accompanied by plain language summaries to assist patients, caregivers and others in understanding important medical advances. The journal also provides the option to include various other types of enhanced features including slide sets, videos and animations. All enhanced features are peer reviewed to the same high standard as the article itself. Peer review is conducted using Editorial Manager®, supported by a database of international experts. This database is shared with other Adis journals.