The COVID-19 pandemic was associated with a 17.5% drop in new sacubitril/valsartan prescriptions, while combination therapy with SGLT2i surged to 54.8% by Q2/2023 following ESC guidelines.
Observational (n=351,262)
Yes
How did the COVID-19 pandemic and the release of ESC guidelines affect the prescription rates of sacubitril/valsartan and SGLT2 inhibitors for heart failure in Germany?
The COVID-19 pandemic temporarily decelerated the uptake of sacubitril/valsartan in Germany, but combination therapy with SGLT2 inhibitors rapidly increased following the 2021 ESC heart failure guidelines.
Background: Guideline-directed medical therapy (GDMT) is the cornerstone in the treatment of patients with heart failure and reduced ejection fraction (HFrEF) and novel substances such as sacubitril/valsartan (S/V) and sodium-glucose co-transporter-2 inhibitors (SGLT2i) have demonstrated marked clinical benefits. We investigated their implementation into real-world HF care in Germany before, during, and after the COVID-19 pandemic period. Methods: The IQVIA LRx data set is based on ∼80% of 73 million people covered by the German statutory health insurance. Prescriptions of S/V were used as a proxy for HFrEF. Time trends were analysed between Q1/2016 and Q2/2023 for prescriptions for S/V alone and in combination therapy with SGLT2i. Findings: The number of patients treated with S/V increased from 5260 in Q1/2016 to 351,262 in Q2/2023. The share of patients with combination therapy grew from 0.6% (29 of 5260) to 14.2% (31,128 of 219,762) in Q2/2021, and then showed a steep surge up to 54.8% (192,429 of 351,262) in Q2/2023, coinciding with the release of the European Society of Cardiology (ESC) guidelines for HF in Q3/2021. Women and patients aged >80 years were treated less often with combined therapy than men and younger patients. With the start of the COVID-19 pandemic, the number of patients with new S/V prescriptions dropped by 17.5% within one quarter, i.e., from 26,855 in Q1/2020 to 22,145 in Q2/2020, and returned to pre-pandemic levels only in Q1/2021. Interpretation: The COVID-19 pandemic was associated with a 12-month deceleration of S/V uptake in Germany. Following the release of the ESC HF guidelines, the combined prescription of S/V and SGLT2i was readily adopted. Further efforts are needed to fully implement GDMT and strengthen the resilience of healthcare systems during public health crises. Funding: Supported by Novartis Pharma GmbH, Nuremberg, Germany.
Kerwagen et al. (Mon,) conducted a observational in Heart failure with reduced ejection fraction (HFrEF) (n=351,262). Sacubitril/valsartan (S/V) and SGLT2 inhibitors was evaluated on Time trends for prescriptions for S/V alone and in combination therapy with SGLT2i. The COVID-19 pandemic was associated with a 17.5% drop in new sacubitril/valsartan prescriptions, while combination therapy with SGLT2i surged to 54.8% by Q2/2023 following ESC guidelines.