Use of guideline-recommended medical therapy in patients with heart failure and chronic kidney disease : from physician's prescriptions to patient's dispensations, medication adherence and persistence
© 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology..
AIM: Half of heart failure (HF) patients have chronic kidney disease (CKD) complicating their pharmacological management. We evaluated physicians' and patients' patterns of use of evidence-based medical therapies in HF across CKD stages.
METHODS AND RESULTS: We studied HF patients with reduced (HFrEF) and mildly reduced (HFmrEF) ejection fraction enrolled in the Swedish Heart Failure Registry in 2009-2018. We investigated the likelihood of physicians to prescribe guideline-recommended therapies to patients with CKD, and of patients to fill the prescriptions within 90 days of incident HF (initiating therapy), to adhere (proportion of days covered ≥80%) and persist (continued use) on these treatments during the first year of therapy. We identified 31 668 patients with HFrEF (median age 74 years, 46% CKD). The proportions receiving a prescription for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors (ACEi/ARB/ARNi) were 96%, 92%, 86%, and 68%, for estimated glomerular filtration rate (eGFR) ≥60, 45-59, 30-44, and <30 ml/min/1.73 m2 , respectively; for beta-blockers 94%, 93%, 92%, and 92%, for mineralocorticoid receptor antagonists (MRAs) 45%, 44%, 37%, 24%; and for triple therapy (combination of ACEi/ARB/ARNi + beta-blockers + MRA) 38%, 35%, 28%, and 15%. Patients with CKD were less likely to initiate these medications, and less likely to adhere to and persist on ACEi/ARB/ARNi, MRA, and triple therapy. Among stoppers, CKD patients were less likely to restart these medications. Results were consistent after multivariable adjustment and in patients with HFmrEF (n = 15 114).
CONCLUSIONS: Patients with HF and CKD are less likely to be prescribed and to fill prescriptions for evidence-based therapies, showing lower adherence and persistence, even at eGFR categories where these therapies are recommended and have shown efficacy in clinical trials.
| Errataetall: |
CommentIn: Eur J Heart Fail. 2022 Nov;24(11):2196-2198. - PMID 36130835 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
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| Enthalten in: |
European journal of heart failure - 24(2022), 11 vom: 12. Nov., Seite 2185-2195 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Janse, Roemer J [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 15.12.2022 Date Revised 13.04.2023 published: Print-Electronic CommentIn: Eur J Heart Fail. 2022 Nov;24(11):2196-2198. - PMID 36130835 Citation Status MEDLINE |
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| doi: |
10.1002/ejhf.2620 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM34371910X |
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| 100 | 1 | |a Janse, Roemer J |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Use of guideline-recommended medical therapy in patients with heart failure and chronic kidney disease |b from physician's prescriptions to patient's dispensations, medication adherence and persistence |
| 264 | 1 | |c 2022 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
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| 500 | |a Date Completed 15.12.2022 | ||
| 500 | |a Date Revised 13.04.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a CommentIn: Eur J Heart Fail. 2022 Nov;24(11):2196-2198. - PMID 36130835 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2022 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. | ||
| 520 | |a AIM: Half of heart failure (HF) patients have chronic kidney disease (CKD) complicating their pharmacological management. We evaluated physicians' and patients' patterns of use of evidence-based medical therapies in HF across CKD stages | ||
| 520 | |a METHODS AND RESULTS: We studied HF patients with reduced (HFrEF) and mildly reduced (HFmrEF) ejection fraction enrolled in the Swedish Heart Failure Registry in 2009-2018. We investigated the likelihood of physicians to prescribe guideline-recommended therapies to patients with CKD, and of patients to fill the prescriptions within 90 days of incident HF (initiating therapy), to adhere (proportion of days covered ≥80%) and persist (continued use) on these treatments during the first year of therapy. We identified 31 668 patients with HFrEF (median age 74 years, 46% CKD). The proportions receiving a prescription for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin receptor-neprilysin inhibitors (ACEi/ARB/ARNi) were 96%, 92%, 86%, and 68%, for estimated glomerular filtration rate (eGFR) ≥60, 45-59, 30-44, and <30 ml/min/1.73 m2 , respectively; for beta-blockers 94%, 93%, 92%, and 92%, for mineralocorticoid receptor antagonists (MRAs) 45%, 44%, 37%, 24%; and for triple therapy (combination of ACEi/ARB/ARNi + beta-blockers + MRA) 38%, 35%, 28%, and 15%. Patients with CKD were less likely to initiate these medications, and less likely to adhere to and persist on ACEi/ARB/ARNi, MRA, and triple therapy. Among stoppers, CKD patients were less likely to restart these medications. Results were consistent after multivariable adjustment and in patients with HFmrEF (n = 15 114) | ||
| 520 | |a CONCLUSIONS: Patients with HF and CKD are less likely to be prescribed and to fill prescriptions for evidence-based therapies, showing lower adherence and persistence, even at eGFR categories where these therapies are recommended and have shown efficacy in clinical trials | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Angiotensin receptor-neprilysin inhibitors | |
| 650 | 4 | |a Beta-blockers | |
| 650 | 4 | |a Chronic kidney disease | |
| 650 | 4 | |a Heart failure | |
| 650 | 4 | |a Mineralocorticoid receptor antagonists | |
| 650 | 4 | |a Renin-angiotensin-aldosterone-system inhibitors | |
| 650 | 7 | |a Angiotensin Receptor Antagonists |2 NLM | |
| 650 | 7 | |a Angiotensin-Converting Enzyme Inhibitors |2 NLM | |
| 700 | 1 | |a Fu, Edouard L |e verfasserin |4 aut | |
| 700 | 1 | |a Dahlström, Ulf |e verfasserin |4 aut | |
| 700 | 1 | |a Benson, Lina |e verfasserin |4 aut | |
| 700 | 1 | |a Lindholm, Bengt |e verfasserin |4 aut | |
| 700 | 1 | |a van Diepen, Merel |e verfasserin |4 aut | |
| 700 | 1 | |a Dekker, Friedo W |e verfasserin |4 aut | |
| 700 | 1 | |a Lund, Lars H |e verfasserin |4 aut | |
| 700 | 1 | |a Carrero, Juan-Jesus |e verfasserin |4 aut | |
| 700 | 1 | |a Savarese, Gianluigi |e verfasserin |4 aut | |
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