Pharmacological treatment patterns in heart failure: a population-based cohort study
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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.
KeywordsHeart failure Treatment patterns Claims database
The authors thank ADERA, Pessac, France, for their technical and administrative support.
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
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 www.pharmacoepi.eu 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.
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