Worsening Heart Failure and Medication Use in HFrEF: A Finnish Retrospective Registry Study and Patient Survey.

Abstract

Background and objectives: Understanding worsening heart failure events (WHFEs) and clinical practices in the real world is essential in heart failure (HF) management. The primary objective of this single-center, retrospective, observational study, including a patient survey, was to characterize WHFEs and associated factors during the first year after the incident HF diagnosis in Finnish patients. Secondly, implementation and adherence to guideline-directed medical therapy (GDMT) and mortality during the whole follow-up were assessed.

Methods: Incident HF patients (International Classification of Diseases, 10th Revision: I50) with reduced ejection fraction (HFrEF; <40%) were identified between 2013-2019 from the hospital data lake of Southwest Finland. Clinical characteristics, healthcare resource utilization, medication prescriptions and purchases, and deaths were collected from hospital records and national registers between 2011-2021. A survey was linked with register data for a subgroup of patients. Associations between explanatory factors, WHFEs, and mortality were studied using logistic and Cox regression models.

Results: Among 570 HFrEF patients, 23% (n=133) experienced a WHFE within the first year after the incident diagnosis. During this 1-year period, 85% used angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, 90% beta-blockers, and 44% mineralocorticoid receptor antagonists, and >80% of patients were adherent to these medications. WHFEs were associated with higher risk of mortality (hazard ratio [HR], 1.82; 95% confidence interval [CI], 1.31-2.53; p<0.001), whereas adherence was associated with a lower risk of WHFEs (odds ratio, 0.31; 95% CI, 0.20-0.48; p<0.001) and mortality (HR, 0.66; 95% CI, 0.47-0.94; p=0.021) in multivariate models. Quality of life was lower in patients with (n=47) than without WHFEs (n=100).

Conclusions: Improving adherence is crucial for mitigating adverse outcomes in HF.