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Impact of the COVID-19 pandemic on implementation of novel guideline-directed medical therapies for heart failure in Germany: a nationwide retrospective analysis.
Kerwagen, Fabian; Riemer, Uwe; Wachter, Rolf; von Haehling, Stephan; Abdin, Amr; Böhm, Michael; Schulz, Martin; Störk, Stefan.
Afiliación
  • Kerwagen F; Department of Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Germany.
  • Riemer U; Department of Internal Medicine I, University Hospital Würzburg, Germany.
  • Wachter R; Medical Department, Novartis Pharma GmbH, Nuremberg, Germany.
  • von Haehling S; Department of Cardiology, University Hospital Leipzig, Germany.
  • Abdin A; Department of Cardiology and Pneumology, University Medical Center Göttingen and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany.
  • Böhm M; Department of Internal Medicine Clinic III, Saarland University Hospital, Homburg/Saar, Germany.
  • Schulz M; Department of Internal Medicine Clinic III, Saarland University Hospital, Homburg/Saar, Germany.
  • Störk S; Institute of Pharmacy, Freie Universität Berlin, Berlin, Germany.
Lancet Reg Health Eur ; 35: 100778, 2023 Dec.
Article en En | MEDLINE | ID: mdl-38023333
ABSTRACT

Background:

Guideline-directed medical therapy (GDMT) is the cornerstone in the treatment of patients with heart failure and reduced ejection fraction (HFrEF) and novel substances such as sacubitril/valsartan (S/V) and sodium-glucose co-transporter-2 inhibitors (SGLT2i) have demonstrated marked clinical benefits. We investigated their implementation into real-world HF care in Germany before, during, and after the COVID-19 pandemic period.

Methods:

The IQVIA LRx data set is based on ∼80% of 73 million people covered by the German statutory health insurance. Prescriptions of S/V were used as a proxy for HFrEF. Time trends were analysed between Q1/2016 and Q2/2023 for prescriptions for S/V alone and in combination therapy with SGLT2i.

Findings:

The number of patients treated with S/V increased from 5260 in Q1/2016 to 351,262 in Q2/2023. The share of patients with combination therapy grew from 0.6% (29 of 5260) to 14.2% (31,128 of 219,762) in Q2/2021, and then showed a steep surge up to 54.8% (192,429 of 351,262) in Q2/2023, coinciding with the release of the European Society of Cardiology (ESC) guidelines for HF in Q3/2021. Women and patients aged >80 years were treated less often with combined therapy than men and younger patients. With the start of the COVID-19 pandemic, the number of patients with new S/V prescriptions dropped by 17.5% within one quarter, i.e., from 26,855 in Q1/2020 to 22,145 in Q2/2020, and returned to pre-pandemic levels only in Q1/2021.

Interpretation:

The COVID-19 pandemic was associated with a 12-month deceleration of S/V uptake in Germany. Following the release of the ESC HF guidelines, the combined prescription of S/V and SGLT2i was readily adopted. Further efforts are needed to fully implement GDMT and strengthen the resilience of healthcare systems during public health crises.

Funding:

Supported by Novartis Pharma GmbH, Nuremberg, Germany.
Palabras clave

Texto completo: 1 Base de datos: MEDLINE Idioma: En Revista: Lancet Reg Health Eur Año: 2023 Tipo del documento: Article País de afiliación: Alemania

Texto completo: 1 Base de datos: MEDLINE Idioma: En Revista: Lancet Reg Health Eur Año: 2023 Tipo del documento: Article País de afiliación: Alemania