Patterns of medication use among patients hospitalized for heart failure
S Matseyko, F Mueller, J Lauffenburger, K Lechner, T Dreischulte, H Schunkert, N KrugerAbstract
Background
Heart failure is the leading cause of hospital admissions in Germany. However, long-term trends in hospitalization rates and medication use patterns surrounding hospitalization remain poorly understood.
Purpose
To examine 10-year trends in heart failure hospitalization incidence and pharmacotherapy, and to assess medication use before, during, and after hospitalization with predictors of post-discharge prescription filling.
Methods
This population-based cohort study used nationwide German claims data from over 10 million individuals. For the trend analysis, adults with an incident heart failure hospitalization (2015–2024) were included, annual age- and sex-adjusted incidence rates were calculated per 100,000 person-years. For the cross-sectional medication analysis, prescription fills of individuals hospitalized from July 2023 through June 2024 were analyzed 91 days before, at discharge (≤91 days), and 92-183 days after hospitalization. Modified Poisson regression estimated adjusted risk ratios for predictors of post-discharge filling. Medication classes included ACEIs, ARBs, ARNIs, beta-blockers, MRAs, loop diuretics, SGLT2 inhibitors, and GLP-1 receptor agonists.
Results
A total of 303,953 incident hospitalizations were identified over 78.9 million person-years. The adjusted incidence rate declined from 473.9 (95% CI, 468.5-479.4) per 100,000 person-years in 2015 to 381.6 (377.1-386.1) in 2020, before rising to 420.0 (415.4-424.7) in 2024. Medication use remained stable except for SGLT2 inhibitors (0.2% to 14.1%). Among 31,708 patients hospitalized in 2023–2024 (median age 83; 57.7% female), prescription fills increased at discharge across all classes, with SGLT2 inhibitors showing the largest gain (12.3% to 42.8%), followed by loop diuretics (46.6% to 71.3%) and MRAs (11.3% to 31.8%). However, use declined within six months post-discharge. The strongest predictor of post-discharge filling was prior use of the same medication; increasing age was associated with lower filling rates, particularly for ACEIs/ARBs/ARNIs. Cardiologist visits were associated with higher initiation, most notably for SGLT2 inhibitors (aRR 1.06 [95% CI 1.03–1.10]).
Conclusions
From 2015 to 2024, heart failure hospitalization rates declined during the COVID-19 pandemic and increased thereafter. While SGLT2 inhibitor adoption grew rapidly, prescription fills for heart failure therapies waned within six months after discharge. These findings reveal a persistent gap between evidence-based recommendations and sustained medication use, underscoring the need for improved post-discharge medication management.