European Journal of Clinical Pharmacology

, Volume 76, Issue 1, pp 97–106 | Cite as

Pharmacological treatment patterns in heart failure: a population-based cohort study

  • Pauline Bosco-LévyEmail author
  • Clélia Favary
  • Jérémy Jové
  • Régis Lassalle
  • Nicholas Moore
  • Cécile Droz-Perroteau
Pharmacoepidemiology and Prescription



Although the efficacy and safety of existing therapies of heart failure (HF) have been demonstrated in clinical trials, little is known about the treatment patterns in clinical practice, especially in France.


To describe the treatment initiation patterns and the subsequent treatment changes among HF patients, in the first year following an incident hospitalization for HF, in a French real-world setting.


A cohort of patients aged ≥ 40 years, with an incident hospitalization for HF between 01/01/2008 and 31/12/2013, was identified in the 1/97th permanent random sample of the French nationwide claims database and followed 1 year. HF drug exposure—beta blockers (BB), angiotensin-converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARBs), aldosterone antagonists (AA), diuretics, digoxin, or ivabradine—was assessed quarterly using a Proportion of Days Covered ≥ 66% (≥ 60 days out of the 90 days of the quarter), by considering HF drugs individually or in combination. Drug changes were assessed between each quarter.


Between 2008 and 2013, 7387 patients were included. Their mean age was 77.7 years (± 12.0 years) and 51.6% were women. During the follow-up, 24.4% died, 20% were not exposed to any HF treatment, 48.3 to 43.2% had diuretics, one third had BB or ACEI, 9% had ARB or AA, 6% had digoxin, and 2% had ivabradine. The main change occurred between the first and the second quarter for 53.1% of the initially untreated patients.


This study provides valuable information on treatment patterns after an initial hospitalization for HF.


Heart failure Treatment patterns Claims database 



The authors thank ADERA, Pessac, France, for their technical and administrative support.

Author contribution

P Bosco-Lévy, N Moore, and C Droz-Perroteau contributed in designing and supervising the study. C Favary, J Jove, and R Lassalle performed the analyses. All authors discussed the results. P Bosco-Lévy wrote the manuscript, and all authors reviewed it.

Compliance with ethical standards

Ethics statement

This study was done in a pseudonymized database, not requiring patient consent. It was reviewed by INSERM internal processes, which did not oppose it. INSERM CIC1401 at that time had permanent access to the 1/97 sample of SNDS, pending INSERM approval.

Conflict of interest

Dr. P. Bosco-Lévy, C Favary, J Jové, R Lassalle, and C Droz-Perroteau have nothing to disclose.

Bordeaux PharmacoEpi (director Pr. N. Moore) has received grants from many pharmaceutical companies (Novartis, Bayer, Boehringer Ingelheim, Merck-Serono, etc., see for a complete list of all research projects) to the University of Bordeaux for regulatory required PASS studies. He declares personal expert consulting fees from Merck-Serono, Ipsen, GSK, Bayer, Sanofi, outside the submitted work.

Supplementary material

228_2019_2758_MOESM1_ESM.docx (181 kb)
ESM 1 (DOCX 181 kb)


  1. 1.
    Maggioni AP, Dahlström U, Filippatos G, Chioncel O, Leiro MC, Drozdz J, Fruhwald F, Gullestad L, Logeart D, Fabbri G, Urso R, Metra M, Parissis J, Persson H, Ponikowski P, Rauchhaus M, Voors AA, Nielsen OW, Zannad F, Tavazzi L, on behalf of the Heart Failure Association of the European Society of Cardiology (HFA) (2013) EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot). Eur J Heart Fail 15:808–817. CrossRefPubMedGoogle Scholar
  2. 2.
    de Peretty C, Pérel C, Tuppin P et al (2014) Prevalence and functional status of coronary heart diseases and heart failure in the adult population in France: contribution of the “Disabilities and Health” cross-sectional surveys. BEHGoogle Scholar
  3. 3.
    Roger VL (2013) Epidemiology of heart failure. Circ Res 113:646–659. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire D, Mohler ER 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB, American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2015) Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation 131:e29–e322. CrossRefPubMedGoogle Scholar
  5. 5.
    Tuppin P, Cuerq A, de Peretti C, Fagot-Campagna A, Danchin N, Juillière Y, Alla F, Allemand H, Bauters C, Drici MD, Hagège A, Jondeau G, Jourdain P, Leizorovicz A, Paccaud F (2014) Two-year outcome of patients after a first hospitalization for heart failure: a national observational study. Arch Cardiovasc Dis 107:158–168. CrossRefPubMedGoogle Scholar
  6. 6.
    Tuppin P, Rivière S, Rigault A, Tala S, Drouin J, Pestel L, Denis P, Gastaldi-Ménager C, Gissot C, Juillière Y, Fagot-Campagna A (2016) Prevalence and economic burden of cardiovascular diseases in France in 2013 according to the national health insurance scheme database. Arch Cardiovasc Dis 109:399–411. CrossRefPubMedGoogle Scholar
  7. 7.
    Dickstein K, Cohen-Solal A, Filippatos G et al (2008) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur J Heart Fail 10:933–989. CrossRefPubMedGoogle Scholar
  8. 8.
    Authors/Task Force Members, McMurray JJV, Adamopoulos S et al (2012) ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. Eur J Heart Fail 14:803–869. CrossRefGoogle Scholar
  9. 9.
    Vorilhon C, Chenaf C, Mulliez A, Pereira B, Clerfond G, Authier N, Jean F, Motreff P, Citron B, Eschalier A, Lusson JR, Eschalier R (2014) Heart failure prognosis and management in over-80-year-old patients: data from a French national observational retrospective cohort. Eur J Clin Pharmacol 71:251–260. CrossRefPubMedGoogle Scholar
  10. 10.
    Tuppin P, Cuerq A, de Peretti C, Fagot-Campagna A, Danchin N, Juillière Y, Alla F, Allemand H, Bauters C, Drici MD, Hagège A, Jondeau G, Jourdain P, Leizorovicz A, Paccaud F (2013) First hospitalization for heart failure in France in 2009: patient characteristics and 30-day follow-up. Arch Cardiovasc Dis 106:570–585. CrossRefPubMedGoogle Scholar
  11. 11.
    Bezin J, Duong M, Lassalle R, Droz C, Pariente A, Blin P, Moore N (2017) The national healthcare system claims databases in France, SNIIRAM and EGB: powerful tools for pharmacoepidemiology. Pharmacoepidemiol Drug Saf 26:954–962. CrossRefPubMedGoogle Scholar
  12. 12.
    Gilleron V, Gasnier-Duparc N, Hebbrecht G (2018) Certification des comptes: Une incitation à la traçabilité des processus de contrôle. Revue Hospitaliere de France 582:6Google Scholar
  13. 13.
    (2016) Méthodologie générale de la cartographie des pathologies développée par la CnamTS pour les années 2012–2013-2014. Caisse Nationale d’Assurance Maladie (CNAM)Google Scholar
  14. 14.
    Kapoor JR, Kapoor R, Ju C, Heidenreich PA, Eapen ZJ, Hernandez AF, Butler J, Yancy CW, Fonarow GC (2016) Precipitating clinical factors, heart failure characterization, and outcomes in patients hospitalized with heart failure with reduced, borderline, and preserved ejection fraction. JACC Heart Fail 4:464–472. CrossRefPubMedGoogle Scholar
  15. 15.
    Miljkovik LV, Spiroska V (2015) Heart failure with preserved ejection fraction – concept, pathophysiology, diagnosis and challenges for treatment. Open Access Maced J Med Sci 3:521–527. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Ho JE, Lyass A, Lee DS, Vasan RS, Kannel WB, Larson MG, Levy D (2013) Predictors of new-onset heart failure: differences in preserved versus reduced ejection fraction. Circ Heart Fail 6:279–286. CrossRefPubMedGoogle Scholar
  17. 17.
    Logeart D, Isnard R, Resche-Rigon M, Seronde MF, de Groote P, Jondeau G, Galinier M, Mulak G, Donal E, Delahaye F, Juilliere Y, Damy T, Jourdain P, Bauer F, Eicher JC, Neuder Y, Trochu JN, on behalf of the working group on Heart Failure of the French Society of Cardiology (2013) Current aspects of the spectrum of acute heart failure syndromes in a real-life setting: the OFICA study. Eur J Heart Fail 15:465–476. CrossRefPubMedGoogle Scholar
  18. 18.
    Donal E, Lund LH, Oger E, Hage C, Persson H, Reynaud A, Ennezat PV, Bauer F, Sportouch-Dukhan C, Drouet E, Daubert JC, Linde C, KaRen Investigators (2014) Baseline characteristics of patients with heart failure and preserved ejection fraction included in the Karolinska Rennes (KaRen) study. Arch Cardiovasc Dis 107:112–121. CrossRefPubMedGoogle Scholar
  19. 19.
    Savarese G, Lund LH (2017) Global public health burden of heart failure. Card Fail Rev 3:7–11. CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Tsutsui H, Tsuchihashi-Makaya M, Kinugawa S (2010) Clinical characteristics and outcomes of heart failure with preserved ejection fraction: lessons from epidemiological studies. J Cardiol 55:13–22. CrossRefPubMedGoogle Scholar
  21. 21.
    Blin P, Dureau-Pournin C, Lassalle R, Jové J, Thomas-Delecourt F, Droz-Perroteau C, Danchin N, Moore N (2017) Outcomes in patients after myocardial infarction similar to those of the PEGASUS-TIMI 54 trial: a cohort study in the French national claims database. Br J Clin Pharmacol 83:2056–2065. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Skrepnek GH, Abarca J, Malone DC, Armstrong EP, Shirazi FM, Woosley RL (2005) Incremental effects of concurrent pharmacotherapeutic regimens for heart failure on hospitalizations and costs. Ann Pharmacother 39:1785–1791. CrossRefPubMedGoogle Scholar
  23. 23.
    Deschaseaux C, McSharry M, Hudson E et al (2016) Treatment initiation patterns, modifications, and medication adherence among newly diagnosed heart failure patients: a retrospective claims database analysis. J Manag Care Spec Pharm 22:561–571. CrossRefPubMedGoogle Scholar
  24. 24.
    Tsuchihashi-Makaya M, Hamaguchi S, Kinugawa S et al (2009) Characteristics and outcomes of hospitalized patients with heart failure and reduced vs preserved ejection fraction. Report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Circ J Off J Jpn Circ Soc 73:1893–1900Google Scholar
  25. 25.
    Fonarow GC, Stough WG, Abraham WT, Albert NM, Gheorghiade M, Greenberg BH, O’Connor CM, Sun JL, Yancy CW, Young JB (2007) Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure: a report from the OPTIMIZE-HF registry. J Am Coll Cardiol 50:768–777. CrossRefPubMedGoogle Scholar
  26. 26.
    Swedberg K, Komajda M, Böhm M, Borer JS, Ford I, Dubost-Brama A, Lerebours G, Tavazzi L (2010) Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study. Lancet 376:875–885. CrossRefPubMedGoogle Scholar
  27. 27.
    Sikka R, Xia F, Aubert RE (2005) Estimating medication persistency using administrative claims data. Am J Manag Care 11:449–457PubMedGoogle Scholar
  28. 28.
    Andrade SE, Kahler KH, Frech F, Chan KA (2006) Methods for evaluation of medication adherence and persistence using automated databases. Pharmacoepidemiol Drug Saf 15:565–574. CrossRefPubMedGoogle Scholar
  29. 29.
    Bosco-Lévy P, Duret S, Picard F, Dos Santos P, Puymirat E, Gilleron V, Blin P, Chatellier G, Looten V, Moore N (2018) Diagnostic accuracy of the International Classification of Diseases, Tenth Revision, codes of heart failure in an administrative database. Pharmacoepidemiol Drug Saf 28:194–200. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Bordeaux PharmacoEpi, INSERM CIC1401Université de BordeauxBordeaux CEDEXFrance
  2. 2.Bordeaux Population Health Research Centre, INSERM UMR 1219Université de BordeauxBordeauxFrance

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