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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

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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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Acknowledgements

This study was funded by Bayer AG; grant number not applicable. We thank Susan Bromley of EpiMed Communications Ltd. for editorial assistance funded by Bayer AG, and in accordance with Good Publication Practice.

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Authors and Affiliations

  1. Bayer Consumer Care AG, Pharmaceuticals, Peter Merian Straße 84, 4052, Basel, Switzerland

    Alexander Michel

  2. Aetion Inc., New York, USA

    Coralie Lecomte & Hanaya Raad

  3. Bayer AG, Berlin, Germany

    Christoph Ohlmeier

  4. InGef-Institute for Applied Health Research, Berlin GmbH, Berlin, Germany

    Frederike Basedow & Dominik Beier

  5. WIG2 GmbH, Leipzig, Germany

    Dennis Haeckl

  6. Bayer AG, Wuppertal, Germany

    Thomas Evers

Authors
  1. Alexander Michel
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  2. Coralie Lecomte
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  4. Hanaya Raad
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  5. Frederike Basedow
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Corresponding author

Correspondence to Alexander Michel.

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Conflict of interests

Alexander Michel, Christoph Ohlmeier, and Thomas Evers are employees of Bayer. Coralie Lecomte is an employee of Aetion, Inc. and holds stock options of Aetion, Inc. Hanaya Raad was an employee of Aetion Inc. at the time of the study and holds stock options of Aetion Inc. Dennis Häckl is an employee of WIG2 GmbH, which has received funding from Bayer AG. Frederike Basedow and Dominik Beier are employed by InGef, which acted as a subcontractor and received funding from WIG2 for the execution of the study.

Funding

This study was funded by Bayer AG (grant number, not applicable).

Ethics approval

This was a retrospective study using de-identified administrative data that received waiver of authorization for use and disclosure of protected health information from US WIRB-Copernicus Group institutional review board on 1 December 2021. No additional approval was required for use of the InGef database due to the data being anonymized.

Consent to participate/publish

Not applicable.

Author contributions

Study concept: A Michel, C Ohlmeier, T Evers. Study design: A Michel, C Lecomte, C Ohlmeier. Analysis of data: H Raad, F Basedow, D Beier. Interpretation of data: A Michel, C Lecomte, C Ohlmeier, D Häckl, D Beier. Writing the first manuscript draft: A Michel. Review of subsequent manuscript drafts: all authors. Approval of the final version for publication: all authors.

Data, material and code availability

Aggregated data are available from the corresponding author upon reasonable request.

Supplementary Information

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Supplementary file1 (PDF 324 KB)

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Michel, A., Lecomte, C., Ohlmeier, C. et al. 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. Am J Cardiovasc Drugs (2024). https://doi.org/10.1007/s40256-024-00643-7

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  • DOI: https://doi.org/10.1007/s40256-024-00643-7

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