Current Practice of Guideline-Directed Medical Therapy After Acute Heart Failure Hospitalization

Abstract

BACKGROUND: Few studies have provided nationwide, longitudinal data on practice patterns of guideline-directed medical therapy (GDMT) for heart failure. OBJECTIVES: The authors aimed to clarify the doses and patterns of up-titration or discontinuation of GDMT following admission for acute heart failure and to determinants associated with its continuation in Japan. METHODS: We retrospectively included data, from the Japanese nationwide health insurance claims database, of patients hospitalized for acute heart failure without a recent history of hospitalization. Patients initiated on GDMTs during hospitalization were followed up for 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, 405,605 (51.2%) were initiated on ≥1 GDMTs during the index hospitalization. These therapies were frequently discontinued within 3 months of discharge. The proportions of patients for whom the target dose was achieved at 12 months were 10.5%, 7.6%, 8.3%, 23.1%, 7.4%, and 60.2% for beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, angiotensin receptor-neprilysin inhibitor, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors, respectively. Beta-blockers and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitor were more likely to be discontinued for older patients with anemia and dementia, whereas mineralocorticoid receptor antagonists were more likely to be discontinued for patients with chronic kidney disease, compared with other GDMT categories. CONCLUSIONS: Initiation and up-titration of GDMTs were insufficient in nationwide clinical practice. Our results may help clinicians improve titration of GDMTs.

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