January 26, 2023American Heart Journal Plus Cardiology Research and PracticeOpen Access

Trends in pharmacotherapy utilization among patients with heart failure with preserved ejection fraction

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Why the study?

Guidelines have changed recommendations for HFpEF management over time, but evidence on trends in the utilization of various pharmacotherapies was limited.

Structured PICO

Population

156,730 patients with heart failure with preserved ejection fraction (HFpEF), mean age 73 years, 57% females, from MarketScan Commercial and Medicare Supplemental Databases (2007-2020).

Intervention

Pharmacotherapy utilization (ACEIs, ARBs, ARNIs, ARAs, diuretics, β-blockers, CCBs, PDE5Is, nitrates, digoxin, and SGLT2i) within 90 days of first HFpEF diagnosis.

Outcome

Trends in utilization rates of pharmacotherapies from 2008 to 2020.

This study highlights shifting prescribing patterns in HFpEF from 2008 to 2020, with increasing use of ARBs, ARNIs, ARAs, and SGLT2 inhibitors, reflecting evolving clinical evidence and guidelines.

Implication

Prescribing changes in HFpEF may mirror new trial data; leaves open whether they improve clinical outcomes.

Abstract

Half of patients with heart failure have preserved ejection fraction (HFpEF). Over the years, guidelines have recommended or advised against various therapies for HFpEF management. However, there is limited evidence on the trends in utilization of the various medications. The aim of this study was to examine the trends in the use of pharmacotherapies among patients with HFpEF from 2008 through 2020. Retrospective cohort study of patients with HFpEF used MarketScan® Commercial and Medicare Supplemental Databases (2007–2020). Patients with HFpEF. Utilization rates for angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitors (ARNIs), aldosterone receptor antagonists (ARAs), diuretics, β-blockers, calcium channel blockers (CCBs), phosphodiesterase 5 inhibitors (PDE5Is), nitrates, digoxin, and sodium glucose cotransporter-2 inhibitors (SGLT2i) within 90 days of the first HFpEF diagnosis. We identified 156,730 patients with HFpEF (mean [SD] age, 73 [13.4] years; 57 % females). From 2008 to 2020, we found increased utilization rates for ARNIs (0.02 % vs. 0.17 % of all patients, p < 0.01), ARBs (14.3 % vs. 18.6 %, p < 0.01), ARAs (7.0 % vs. 8.4 %, p < 0.01), CCBs (30.6 % vs. 33.4 %, p < 0.01), and SGLT2i (0.001 % vs. 0.021 %, p < 0.01). By contrast, the utilization of ACEIs (30.4 % vs. 20.5 %, p < 0.01), digoxin (9.5 % vs. 2.4 %, p < 0.01), nitrates (10.7 % vs. 4.9 %, p < 0.01), diuretics (54.1 % vs. 50.4 %, p = 0.20), and β-blockers (52.6 % vs. 51.7 %, p < 0.01) decreased, while utilization rates of PDE5Is remained stable (1.5 % vs. 1.1 %, p = 0.90) . During the 13-year study period, the utilization of ARNIs, ARBs, ARAs, CCBs, and SGLT2i increased while the utilization of digoxin, nitrates, diuretics, and β-blockers decreased among patients with HFpEF.