Key result
Among patients hospitalized for heart failure in Japan, only 19.27% received guideline-directed triple therapy at discharge, with significant regional variations and decreased use associated with older age and chronic kidney disease.
Why the study?
Data on triple therapy for heart failure across all eight regions of Japan and the reasons guiding this therapeutic selection needed clarification.
Observational (n=51,933)
Yes
In a Japanese nationwide claims database, only 19.27% of hospitalized heart failure patients received guideline-directed triple therapy at discharge, highlighting significant regional variations and underutilization in older patients and those with CKD.
Answers are grounded in this paper and cite their sources.
Regional disparities in triple therapy signal potential HF care inequities; leaves open whether targeted interventions can improve standardization.
BACKGROUND: This study aimed to collect data on "triple therapy" for heart failure (HF) with angiotensin-converting enzyme inhibitors (or receptor blockers), β-blockers, and mineralocorticoid receptor antagonists in all eight regions of Japan and clarify the reason for the selection of this therapeutic approach. METHODS AND RESULTS: We used data from April 2017 to March 2018 from the Medical Data Vision database (380 facilities) to analyze factors impacting triple therapy for HF. Among patients who were hospitalized for HF during the study period, 51,933 patients met the inclusion criteria and underwent further analyses. A reference value of 20.45% from Kanto was used to compare the eight Japanese regions. From the patient cohort, 10,006 (19.27%) patients receiving triple therapy were identified. The highest and lowest rates of triple therapy were in Chugoku (21.90%) and Shikoku (14.27%), respectively, suggesting regional differences in the use of triple therapy at discharge for patients with HF (P < 0.001). Regression analysis revealed a decrease in the administration of triple therapy for patients with chronic kidney disease (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.43-0.48]; P < 0.001), those aged 75 years and older (OR, 0.46, 95% CI: 0.44-0.49; P < 0.001), those from Shikoku (OR, 0.69; 95% CI, 0.60-0.80; P < 0.001), those with chronic obstructive pulmonary disease (OR, 0.75; 95% CI, 0.68-0.84; P < 0.001), those with anemia (OR, 0.78; 95% CI, 0.62-0.98; P = 0.034), and those from Tohoku (OR, 0.83; 95% CI, 0.75-0.92; P < 0.001). CONCLUSIONS: Future efforts to rectify the regional variance in drug therapy conforming to the guidelines for the treatment of acute and chronic HF will help to extend the healthy lifespans of patients with HF. Further clarification is required to determine instances where triple therapy should be avoided based on patient factors, and appropriate countermeasures should be identified.
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Abe et al. (2021) conducted an observational in Heart Failure (n=51,933). Triple therapy (ACEIs/ARBs, β-blockers, and MRAs) vs. Non-triple therapy was evaluated on Prescription rate of triple therapy at discharge (p=<0.001). Among patients hospitalized for heart failure in Japan, only 19.27% received guideline-directed triple therapy at discharge, with significant regional variations and decreased use associated with older age and chronic kidney disease.
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