Utilization patterns and determinants of guideline-recommended therapies for acute heart failure in Denmark

Abstract Aims Acute heart failure (AHF) is a leading cause of frequent hospitalizations and poor outcomes. While chronic HF is treated with guideline-directed medical therapy, acute hospital care often requires loop diuretics, vasodilators, inotropes, and vasopressors. This study aimed to evaluate the inpatient use, dosing, and determinants of guideline-recommended therapies in patients hospitalized with AHF. Methods and results This nationwide, register-based cohort study included 6,009 patients aged ≥45 years hospitalized with AHF with (left ventricular ejection fraction LVEF ≤40%) in Denmark from 2018–2023. Data from the Danish Heart Failure Registry were linked to national healthcare registers. The main outcomes were inpatient use and doses of loop diuretics, vasodilators, inotropes, and vasopressors. Loop diuretics were used in 88.7% of patients (median dose MD of furosemide: 50 mg parenteral, 40 mg oral). Vasodilators were administered to 36.1% (MD of nitroglycerin: 30 mg parenteral, 7.5 mg oral). Inotropes were administered to 3.0%, including dopamine (0.5%), dobutamine (1.0%), milrinone (0.9%), and levosimendan (1.1%). Vasopressors were used in 8.4%, with norepinephrine (7.3%) and epinephrine (2.0%). Older patients (≥75) had lower prevalence of vasodilator, inotrope, and vasopressor use. Severe HF (LVEF 25%) was associated with lower prevalence of vasodilator and vasopressor use. In contrast, chronic kidney disease and recurrent HF hospitalization were linked to higher prevalence of use of all AHF therapies. Conclusions Loop diuretics were widely used, while vasodilators, inotropes, and vasopressors had lower utilization. The observed variation in treatment reflects complexity of inpatient AHF management, warranting further studies to assess treatment outcomes.