TOPLINE

Patients diagnosed with heart failure (HF) before updates in clinical guidelines were less likely to initiate angiotensin receptor-neprilysin (ARN) inhibitors or SGLT2 inhibitors than those diagnosed after the updates.

METHODOLOGY

• Researchers conducted a cohort study using data from Danish registers to examine the uptake of new therapies among patients diagnosed with HF before vs after relevant updates in clinical guidelines.
• The study covered two drug classes: ARN inhibitors, recommended by the European Society of Cardiology in July 2016, and SGLT2 inhibitors, recommended by the Danish Society of Cardiology in May 2021. Adults diagnosed up to 3 years before each recommendation were compared with those diagnosed after the respective recommendation through December 2021.
• The ARN inhibitor analysis included 17,335 and 43,625 patients diagnosed before and after the recommendation, respectively, and the SGLT2 inhibitor analysis included 18,056 and 5109 patients, respectively. The mean age of the patients was 71-73 years, and about 35% were women.
• The primary outcome was access to treatment with either ARN or SGLT2 inhibitors, identified as the first prescription for either drug that the patient collected from a pharmacy. Analyses were adjusted for comorbidities and demographic and socioeconomic factors.
• The mean follow-up durations were 2185 and 850 days for patients diagnosed before and after the recommendation of ARN inhibitors, respectively, and 870 and 185 days, respectively, for SGLT2 inhibitors.

TAKEAWAY

• Patients diagnosed with HF before updates in relevant guidelines were 43% less likely to initiate ARN inhibitors than those diagnosed after the updates (P < .001).
• Similarly, patients diagnosed with HF before updates in relevant guidelines were 28% less likely to initiate SGLT2 inhibitors than those diagnosed after the updates (P < .001).
• Results remained similar in patients likely to have reduced ejection fraction and in those with a hospital visit after the updates, and for SGLT2 inhibitors, in those without diabetes.

IN PRACTICE

"Addressing [the] implementation gap may require targeted interventions, such as clinical decision-support tools, systematic review of patient lists and proactive recall of eligible patients for treatment optimisation," the researchers wrote.

SOURCE

The study was led by Maria Klitgaard Christensen of the University of Southern Denmark, Odense, Denmark. It was published online on October 8 in Heart.

LIMITATIONS

Researchers lacked data on left ventricular ejection fraction; thus, some patients may not have been eligible for the new therapy. They also lacked information on patient preferences, and some patients may have intentionally declined the recommended treatment.

DISCLOSURES

The study received funding from the Independent Research Fund Denmark. The authors did not declare any competing interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.