Worsening Heart Failure and Medication Use in HFrEF: A Finnish Retrospective Registry Study and Patient Survey

Figure 1. Formation of the main study population and the survey subpopulation. The main study population is patients with HFrEF. HF = heart failure; HFmrEF = heart failure with mid-range ejection fraction; HFpEF = heart failure with preserved ejection fraction; HFrEF = heart failure with reduced ejection fraction; ICD-10 = International Classification of Diseases, 10th Revision; LVEF = left ventricular ejection fraction; nWHF = patients without WHFE during the first year after the index date; WHF = patients with WHFE during the first year after the index date; WHFE = worsening heart failure event; QoL = quality of life.

Figure 2. Predisposing factors for WHFE for 1 year follow-up. The association (odds ratio) between the pre-selected predisposing factors and the binary outcome of whether or not a patient had the WHFE during the first year of follow-up, in patients with HFrEF, evaluated by a logistic regression model. Adherence was evaluated for each ATC group for a 1-year time period up to 1 year after the index date, end of follow-up, or first WHFE, whichever came first. Within this evaluation period, adherence was calculated as the number of 3-month windows with a refill purchase divided by the total number of time windows. A minimum adherence across ATC groups was used in the analysis. ATC = Anatomic Therapeutic Chemical; CRP = C-reactive protein; eGFR = estimate glomerular filtrate rate; HFrEF = heart failure with reduced ejection fraction; NT-proBNP = N-terminal pro B-type natriuretic peptide; WHFE = worsening heart failure event.

Figure 3. The association (hazard ratio) between all-cause mortality and explanatory factors evaluated by Cox regression model. Adherence was evaluated for each ATC group for 1-year time period up to 1 year after the index date, end of follow-up, or first WHFE, whichever came first. Within this evaluation period, adherence was calculated as the number of 3-month windows with a refill purchase divided by the total number of time windows. A minimum adherence across ATC groups was used in the analysis. The multicomorbidity index is defined as a count of distinct ICD-10 codes with 3-digit accuracy, and polypharmacy index as a count of distinct ATC codes with 4-digit accuracy. ATC = Anatomic Therapeutic Chemical; ICD-10 = International Classification of Diseases, 10th Revision; WHF = patients with WHFE during the first year after the index date; WHFE = worsening heart failure event.

Figure 4. QoL in the survey population. QoL was measured by VAS score in the EQ-5D-5L questionnaire, stratified by whether or not the patient had a worsening heart failure episode during 2018–2020 (n=35 and n=67, respectively). QoL = quality of life; VAS = visual analog scale.