Guideline-directed medical therapy presciption after acute heart failure hospitalization in Japan

Background There is a lack of comprehensive nationwide studies analyzing the long-term practice patterns of guideline-directed medical therapy (GDMT) for heart failure. Purpose The purpose of our study was to investigate the dosing and patterns of up-titration or discontinuation of GDMT after hospitalization for acute heart failure. Methods We analyzed data from the Japanese nationwide health insurance-claims database covering almost all insured populations. Patients hospitalized for acute heart failure without a recent history of hospitalization were included. GDMT use during hospitalization and after discharge was described up to 12 months. We analyzed patient baseline characteristics associated with continuation 12 months after discharge by using a logistic regression model. Results Of 791,917 included patients, 166,120 (21.0%) were aged 70–79 years, 329,319 (41.6%) were aged 80–89 years, 392,370 (49.5%) were female. During the index hospitalization, the prescription rate was 435,169 (55.0%) for beta blockers, 184,201 (23.3%) for angiotensin-converting enzyme (ACE) inhibitors, 249,521 (31.5%) for angiotensin receptor blockers (ARBs), and 366,378 (46.3%) for mineralocorticoid receptor antagonists (MRAs), respectively. Of these, 405,605 (51.2%) were initiated on ≥1 GDMTs during the index hospitalization. These therapies were frequently discontinued within three months of discharge. The proportions of patients who achieved target dose at 12 months were 10.5%, 7.6%, 8.3%, 23.1%, 7.4%, and 60.2% for beta blockers, ACE inhibitors, ARBs, angiotensin receptor-neprilysin inhibitor, MRAs, and sodium-glucose cotransporter 2 inhibitors, respectively. Beta blockers and ACE inhibitors/ARBs/angiotensin receptor-neprilysin inhibitor were more likely to be discontinued for older patients with anemia and dementia, whereas MRAs were more likely to be discontinued for patients with chronic kidney disease, compared with other GDMT categories. Conclusion The initiation and up-titration of GDMTs were found to be inadequate in the current clinical practice. Our findings may support clinicians in optimizing GDMT titration.