Twenty‐year time trends in use of evidence‐based heart failure drug therapy in Denmark

Abstract

European guidelines for heart failure (HF) have continuously incorporated new evidence since the first publication in 1995. We aimed to explore time trends in utilisation of pharmacological treatment for HF and dispensing of recommended dosages among patients with a first‐time diagnosis of HF. We performed a historical cohort study of patients with a first‐time HF diagnosis from 1997 to 2015, identified in the Danish National Patient Registry. Dispensed pharmacological treatment included angiotensin‐converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta‐blockers, mineralocorticoid receptor blockers (MRAs), digoxin and diuretics. Furthermore, we estimated the proportion of patients receiving the recommended target dosages 1 year after the diagnosis. The utilisation increased and correlated with publication of landmark studies, and among patients diagnosed in 2015, approximately two of three received ACEI/ARB and beta‐blocker, respectively. Less than half of the patients redeeming prescriptions for ACEIs, ARBs, beta‐blockers or MRAs received the recommended target dosages. The utilisation of pharmacological therapy for HF appears to be correlated with the publications of landmark Phase III clinical trials. However, a high proportion of patients do not receive the recommended target dosages. Despite improvements over time, a substantial gap appears to remain between guideline recommendations and pharmacological therapy in routine care.

Polypharmacy among older individuals with heart failure: trends between 2000 and 2017 in the province of Quebec, Canada

“… 9 In individuals aged ⩾30 years in Denmark, the use of ACEIs/ARBs increased from 10% to 35% between 1997 and 2015, while the use of β-blockers increased from 20% to 70%. 25 Conversely, the use of digoxin and diuretics decreased by an absolute 20% and 15%, 25 a trend that we also observed in our data. The decrease in the use of diuretics and digoxin over time might be explained by the more appropriate control of heart failure in the population.…”

“…decreased by an absolute 20% and 15%, 25 a trend that we also observed in our data. The decrease in the use of diuretics and digoxin over time might be explained by the more appropriate control of heart failure in the population.…”

“…9 In individuals aged ⩾30 years in Denmark, the use of ACEIs/ARBs increased from 10% to 35% between 1997 and 2015, while the use of βblockers increased from 20% to 70%. 25 Conversely, the use of digoxin and diuretics Non-DHP CCBs, nondihydropyridine calcium channel blockers; TZD, thiazolidinediones. Age-and sex-standardized proportions using 2001 Quebec standard population weights.…”