In a German primary care cohort, guideline-directed medical therapy for heart failure was underutilized, with only 17.8% receiving SGLT2 inhibitors and NT-proBNP testing absent in 97.7% at diagnosis.
Cross-Sectional (n=448,837)
Yes
Real-world data from German primary care reveals substantial gaps in heart failure management, characterized by profound underutilization of NT-proBNP screening and significant delays in initiating guideline-directed medical therapies.
Abstract Background Heart failure (HF) is a complex syndrome with significant morbidity and mortality. Guideline-directed medical therapy (GDMT) is essential for improving outcomes; however, recent national data for HF care decision-making and treatment are limited. Purpose This analysis aimed to evaluate the prevalence, diagnosis, and treatment patterns of chronic HF in German primary care settings based on a retrospective cross-sectional analysis of real-world data. Methods As part of the InspeCKD study, WATCH-HF examined treatment patterns for chronic HF using anonymised data from 1,244 primary care practices across Germany. The cohort included adults (≥18 years) with risk factors such as hypertension, diabetes, and cardiovascular disorders (including HF). Diseases were identified through ICD-10 codes for HF covering all phenotypes. Data were collected during routine clinical visits between June 2020 and June 2023. Results The full cohort comprised 448,837 patients, with 12.2% (n=54,721) diagnosed with HF. HF patients' mean age was 74 years, 52.8% were female; the average follow-up period was 1.7 years. Considerable geographic disparities across Germany were observed. GDMT implementation varied significantly: 76.2% received renin-angiotensin system inhibitors (RAASi), 66.4% beta-blockers (BB), 58.6% diuretics, 24% mineralocorticoid receptor antagonists (MRA), and 17.8% sodium glucose cotransporter 2 inhibitors (SGLT2i). SGLT2i were prescribed in only 8.8% of cases within 26 weeks of a new HF diagnosis. Substantial delays were observed in initiating GDMT. Mean time from index date to initiation was 4.8 weeks for diuretics, 6 weeks for RAASi, 6.2 weeks for MRA, 6.7 weeks for BB, and 7 weeks for SGLT2i. Despite double indications for SGLT2 inhibitors (HF and CKD), 83.7% of eligible patients were not prescribed this class of medication. N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing was performed in only 2.1% of the at-risk cohort, and absent in 97.7% of HF patients at diagnosis. Conclusion The WATCH-HF study highlights substantial gaps in the diagnosis and treatment of HF in German primary care settings. The underutilization of NT-proBNP testing indicates a lack of screening, leading to underdiagnosis of HF and delay of prognosis-improving GDMT. Although extensive, the dataset may contain biases due to reliance on routine care data and lack of differentiation among HF phenotypes. Nevertheless, the findings underscore the need for improved awareness of and systematic screening for HF in Germany. Optimisation of treatment initiation timelines is a critical step towards enhancing HF management and outcome and will require strong collaboration between cardiologists and primary care physicians.
Wassmann et al. (Sat,) conducted a cross-sectional in Chronic heart failure (n=448,837). Guideline-directed medical therapy (GDMT) was evaluated on Prevalence, diagnosis, and treatment patterns of chronic HF. In a German primary care cohort, guideline-directed medical therapy for heart failure was underutilized, with only 17.8% receiving SGLT2 inhibitors and NT-proBNP testing absent in 97.7% at diagnosis.