Real-world treatment patterns in newly diagnosed heart failure patients stratified by ejection fraction subtype in Japan

Abstract Purpose To describe real-world treatment patterns and clinical characteristics of newly diagnosed HF patients categorized by left ventricular ejection fraction (LVEF) in Japan. Method A retrospective observational cohort study using a Japanese hospital-based administrative database was conducted. Adult patients with a first confirmed diagnosis of HF from January 1, 2020 to July 31, 2023 and 364 days of baseline data were included. Patient characteristics were described at baseline. Utilization patterns of HF medications, including angiotensin-converting enzyme inhibitor (ACEi), angiotensin receptor blocker (ARB), angiotensin receptor blocker neprilysin inhibitor (ARNi), steroidal mineralocorticoid receptor antagonist (sMRA), sodium-glucose co-transporter-2 inhibitor (SGLT2i), and beta blockers (BB) were assessed until 24 months or censorship (death, heart transplant, ventricular assist device use). Results A total of 16,001 newly diagnosed HF patients were identified, among which 5,473 (34%), 3,053 (19%), and 7,475 (47%) had HFrEF, HFmrEF, and HFpEF, respectively. Patients with HFpEF were older (mean age: 83 years) and more often women (56%) than those with HFrEF and HFmrEF (Table). Among HF types, the HFpEF group had highest prevalence of anemia (23%), valvular heart disease (18.1%) and obesity (6.7%), and lowest prevalence of coronary artery disease (24.8%). Overall, 61% of patients had hypertension, 64% had CKD stage 3-5, and 37% had diabetes mellitus. Within first 6 months of follow up, the prescription rates of HF medications in overall were: ACEi 17.4%, ARB 41.1%, ARNi 25.3%, BB 57.6%, sMRA 55.7%, and SGLT2i 33.2%. Utilization patterns of HF medication after the first HF diagnosis in overall and by LVEF subgroups are shown in Figure. Uptake of HF medications showed only a slight increase across all LVEF types and medication classes from 6 to 12 months post diagnosis and onward throughout the follow up period. Notably, medication uptake was lowest among HFpEF patients. Even with established HF treatments for HFpEF such as ARNi and SGLT2i, the initiation rate remained comparatively low at 12 (20.7% and 25.8%, respectively) and 24 months (21.8 and 26.9% respectively). Conclusion In patients with newly diagnosed HF, HF treatment initiation was followed with only modest treatment optimization over the 6 months and during the follow up, regardless of LVEF type. These real-world data underscore opportunities for improved implementation of HF GDMT in all LVEF types.