In newly diagnosed heart failure patients in Japan, prescription rates of guideline-directed medical therapies within 6 months were suboptimal, with SGLT2 inhibitors prescribed in only 33.2% of patients, and HFmrEF and HFpEF associated with lower hazards of treatment initiation compared to HFrEF.
Cohort (n=16,001)
Yes
In newly diagnosed heart failure patients in Japan, the uptake of guideline-directed medical therapies remains suboptimal across all ejection fraction subtypes, despite high rates of in-hospital mortality and cardiovascular events.
Abstract There is a limited understanding of the uptake of pharmacological treatments and incidence of clinical events in newly diagnosed heart failure (HF) patients, stratified by left-ventricular ejection fraction (LVEF) in contemporary clinical settings in Japan. A retrospective cohort study was conducted using a nationwide Japanese hospital database to evaluate the patterns of HF medications and clinical events in adult patients with a first confirmed HF diagnosis from January 1, 2020–July 31, 2023 (n = 16,001). Fine-Gray sub-distribution hazard models were applied to assess factors associated with HF medication initiations and clinical events. Overall, 5473 (34.2%), 3053 (19.1%), and 7475 (46.7%) patients with HF with reduced ejection fraction, mildly reduced ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF) were included, respectively. Within the first 6 months, prescription rates of HF medications were: angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, or angiotensin receptor blocker-neprilysin inhibitor (65.6%), beta-blockers (57.6%), mineralocorticoid antagonists (55.7%), and sodium-glucose cotransporter-2 inhibitors (33.2%), with the lowest rates in HFpEF patients. The increase in prescription rates between 6 and 12 months was modest across all medication classes. One-year incidence rates per 100 person-years (95% confidence interval) of in-hospital all-cause mortality and in-hospital cardiovascular death were 23.0 (22.1–24.0) and 16.6 (15.8–17.4), respectively. HFmrEF and HFpEF were associated with lower hazards of treatment initiation for most HF medications, whereas the risks of in-hospital all-cause mortality and in-hospital cardiovascular death did not differ significantly across all LVEF subtypes. The findings underscore the suboptimal uptake of pharmacological treatments, despite the poor prognosis of newly diagnosed HF patients. The disparities in initiations of recommended treatments reaffirm the importance of properly implementing evidence-based therapies within each LVEF subtype.
Sato et al. (Fri,) conducted a cohort in Newly diagnosed heart failure (n=16,001). Heart failure stratified by LVEF (HFrEF, HFmrEF, HFpEF) vs. HFrEF (for comparisons of treatment initiation and clinical events) was evaluated on Prescription rates of heart failure medications within the first 6 months. In newly diagnosed heart failure patients in Japan, prescription rates of guideline-directed medical therapies within 6 months were suboptimal, with SGLT2 inhibitors prescribed in only 33.2% of patients, and HFmrEF and HFpEF associated with lower hazards of treatment initiation compared to HFrEF.