In patients with incident comorbid HF and CKD, GDMT use was low at diagnosis and increased modestly; quadruple therapy remained under 10% at 12 months across Japan, Sweden, and the USA.
What are the rates of guideline-directed medical therapy utilization in patients with incident comorbid heart failure and chronic kidney disease?
There are major gaps in GDMT utilization with low rates of medication initiation at diagnosis and during longitudinal follow-up in patients with incident comorbid HF and CKD across Japan, Sweden, and the USA.
Absolute Event Rate: 0% vs 0%
Abstract Background Heart failure (HF) is often complicated by chronic kidney disease (CKD). Although outcomes in patients with both conditions are substantially worse than those with HF alone, CKD is often reported as a barrier to the implementation of HF guideline-directed medical therapy (GDMT) in daily clinical practice. Purpose This analysis from The CaRe Study describes the patient profile and GDMT utilization in contemporary cohorts of patients with incident comorbid HF and CKD in Japan, Sweden and the USA. Methods This was an observational longitudinal cohort study using electronic health record data from Japan (Medical Data Vision database), Sweden (nationwide administrative registries) and the USA (Optum’s de-identified Clinformatics® Data Mart Database). Adults were included if they were diagnosed with incident comorbid HF and CKD from 26 August 2021 to 30 November 2023 in Japan, 21 December 2021 to 31 December 2023 in Sweden and 30 October 2021 to 30 June 2024 in the USA. HF and CKD were defined according to the respective recorded diagnosis codes. Index date was defined as the first date that a patient received the diagnosis codes for both HF and CKD during the study window. Medication utilization from 6 months before index until 12 months after index was described for sodium-glucose co-transporter 2 inhibitors SGLT2i, mineralocorticoid receptor antagonists (MRA), renin–angiotensin system inhibitors (RASi), beta-blockers, and for all four GDMTs together (quadruple therapy). Results In total, 1 327 058 patients with incident comorbid HF and CKD were identified: 119 182, 37 094 and 1 170 782 from Japan, Sweden and the USA, respectively (Table). Median age was 81, 81 and 78 years in Japan, Sweden and the USA, respectively; 42%, 43% and 51% were female. Prior to index, GDMT utilization was low across countries, particularly for SGLT2i, MRA and quadruple therapy, although rates were higher in Sweden (Figure). At index, modest increases in GDMT utilization were seen across countries. Modest changes from index to 12 months after index was observed across countries (SGLT2i: from 7 to 16%, 17 to 30% and 4 to 9%; MRA: from 8 to 12%, 23 to 26% and 7 to 10%; RASi: from 20 to 31%, 60 to 60% and 39 to 42%; beta-blockers: from 18 to 31%, 68 to 75% and 40 to 49%; quadruple therapy: from 1 to 4%, 6 to 9% and 1 to 1%, in Japan, Sweden and the USA, respectively; Figure). Conclusion In this multinational longitudinal study of patients with incident comorbid HF and CKD, there were major gaps in GDMT utilization with low rates of medication initiation at diagnosis and during longitudinal follow-up.
Greene et al. (Sat,) reported a other. In patients with incident comorbid HF and CKD, GDMT use was low at diagnosis and increased modestly; quadruple therapy remained under 10% at 12 months across Japan, Sweden, and the USA.