Contemporary characteristics and treatment patterns of patients with HFmrEF and HFpEF in Germany. A cross-sectional survey
A Michel, S Glueck, M Klutmann, S StoerkAbstract
Background and purpose
Patients with heart failure and a left ventricular ejection fraction (LVEF) >40 % account for more than half of heart failure cases, yet real-world data on their characteristics and treatment patterns are limited. We sought to describe contemporary patient characteristics and management in routine clinical care in Germany for those with mildly reduced (HFmrEF) or preserved ejection fraction (HFpEF). In addition, we identified predictors of receiving treatment with sodium-glucose cotransporter-2 inhibitors (SGLT2i).
Methods
We conducted a cross-sectional analysis using electronic records from 51 ambulatory cardiology practices participating in the Bundesverband Niedergelassener Kardiologen network across Germany. Records from 2022-2024 were reviewed to collect demographics, medical history, comorbidities, echocardiography findings and medications. Patients were eligible if they had a diagnosis of heart failure confirmed by a hospital or by a cardiologist practice, had treatment data available for at least 6 months, and had an LVEF >40 %. We included 1,000 patients per calendar year to obtain a total sample of 3,000. Patients with distinct etiologies such as amyloidosis, hypertrophic cardiomyopathy, Fabry disease, or improved LVEF (i.e., any prior measurement of <40%), were excluded. To identify predictors of SGLT2i therapy, we fitted a multivariable logistic regression model considering demographics, medications and comorbidities.
Results
Among the 3,000 patients included, one third had HFmrEF and two thirds had HFpEF. Demographic and clinical characteristics are displayed in the Table (top). Median time since diagnosis was longer in HFmrEF (41 months) compared to HFpEF (33 months). Use of steroidal mineralocorticoid receptor antagonists (MRA), angiotensin receptor–neprilysin inhibitors (ARNi) and SGLT2i was more frequent in HFmrEF compared to HFpEF (Figure). The severity of heart failure, as evidenced by NYHA stage, natriuretic peptides or recent heart failure hospitalisation, was similar between both groups. Significant predictors for SGLT2i use identified in the multivariable analysis are displayed in the Table (bottom).
Conclusions
As expected, patients with HFmrEF shared more characteristics with HFrEF, including a higher proportion of men, more coronary artery disease and hyperlipoproteinemia, and a younger age at diagnosis, compared with HFpEF. Treatment patterns differed, with greater use of steroidal MRA, ARNi and SGLT2i in HFmrEF. SGLT2i use was significantly associated with diabetic status (as reflected by HbA1c), younger age, comedication with ARNI, but also the absence of hyperlipoproteinemia. These observations merit further investigation.For image description, please refer to the figure legend and surrounding text.Figure 1For image description, please refer to the figure legend and surrounding text.