Pharmacological treatments and clinical events in newly diagnosed heart failure patients stratified by ejection fraction in Japan

Abstract

Abstract There is a limited understanding of the uptake of pharmacological treatments and incidence of clinical events in newly diagnosed heart failure (HF) patients, stratified by left-ventricular ejection fraction (LVEF) in contemporary clinical settings in Japan. A retrospective cohort study was conducted using a nationwide Japanese hospital database to evaluate the patterns of HF medications and clinical events in adult patients with a first confirmed HF diagnosis from January 1, 2020–July 31, 2023 (n = 16,001). Fine-Gray sub-distribution hazard models were applied to assess factors associated with HF medication initiations and clinical events. Overall, 5473 (34.2%), 3053 (19.1%), and 7475 (46.7%) patients with HF with reduced ejection fraction, mildly reduced ejection fraction (HFmrEF), and preserved ejection fraction (HFpEF) were included, respectively. Within the first 6 months, prescription rates of HF medications were: angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, or angiotensin receptor blocker-neprilysin inhibitor (65.6%), beta-blockers (57.6%), mineralocorticoid antagonists (55.7%), and sodium-glucose cotransporter-2 inhibitors (33.2%), with the lowest rates in HFpEF patients. The increase in prescription rates between 6 and 12 months was modest across all medication classes. One-year incidence rates per 100 person-years (95% confidence interval) of in-hospital all-cause mortality and in-hospital cardiovascular death were 23.0 (22.1–24.0) and 16.6 (15.8–17.4), respectively. HFmrEF and HFpEF were associated with lower hazards of treatment initiation for most HF medications, whereas the risks of in-hospital all-cause mortality and in-hospital cardiovascular death did not differ significantly across all LVEF subtypes. The findings underscore the suboptimal uptake of pharmacological treatments, despite the poor prognosis of newly diagnosed HF patients. The disparities in initiations of recommended treatments reaffirm the importance of properly implementing evidence-based therapies within each LVEF subtype.