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Treatment of chronic heart failure in Germany: a retrospective database study
Stefan Störk1, Renate Handrock2, Josephine Jacob3,4
1Comprehensive Heart Failure Centre Würzburg and Department of Internal Medicine I, University and University Hospital Würzburg, Am Schwarzenberg 15, 97078, Würzburg, Germany. Stoerk_S@ukw.de.
Insights
In Germany, family practitioners are key in diagnosing and treating heart failure (HF). However, many patients with HF do not receive guideline-recommended treatments, impacting outcomes.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Adherence to treatment guidelines is crucial for managing chronic heart failure (HF) outcomes.
- Understanding patient care pathways and treatment patterns in HF is essential for improving care.
Purpose of the Study:
- To investigate patient pathways and treatment patterns for heart failure (HF) in Germany.
- To evaluate adherence to European Society of Cardiology (2008) and German Nationale VersorgungsLeitlinien (2011) guidelines.
Main Methods:
- Retrospective analysis of anonymous German healthcare claims data (2009-2013).
- Inclusion criteria: uninterrupted data, ≥2 HF diagnoses in 2011, and identification of newly diagnosed HF patients.
- Evaluation of treatment patterns against established cardiology and national guidelines.
Main Results:
- Of 123,925 HF patients, 21.3% were newly diagnosed, primarily in ambulatory settings (63.2%) by family practitioners.
- Family practitioners managed initial treatment, while specialists performed diagnostics; only 20.9% received NYHA classification.
- Guideline-based treatment was applied in 45.1% of classified patients, decreasing with disease severity and older age.
Conclusions:
- Family practitioners are central to HF diagnosis and initial management in Germany.
- A significant number of HF patients do not receive guideline-recommended pharmacotherapy.
- Findings highlight the need to integrate these insights into national disease management programs for HF.
Background:
Adherence to treatment guidelines affects outcomes in patients with chronic heart failure (HF). We investigated patient pathways and treatment patterns for HF in Germany.
Methods:
This retrospective study used anonymous healthcare claims data from the German Health Risk Institute on individuals with statutory health insurance. Patients with uninterrupted data from 1 January 2009 to 31 December 2013 or death (whichever occurred first), and ≥2 recorded HF-related diagnoses in 2011, were included. Patients with newly diagnosed HF were identified. Use of treatment patterns recommended by the European Society of Cardiology (2008) and German Nationale VersorgungsLeitlinien (2011) guidelines was evaluated.
Results:
Of 123,925 patients with HF, 21.3% were newly diagnosed. Overall, 63.2% of new HF diagnoses were made in the ambulatory setting; 61.6% of these were made by family practitioners and 14.8% by cardiologists. In the ambulatory setting, family practitioners were primarily responsible for treatment; specialists in internal medicine (70.3% cardiologists) were mainly responsible for performing HF-related technical diagnostics. One-fifth (20.9%) of patients received a New York Heart Association (NYHA) classification; 45.1% of these received a guideline-based treatment pattern. Application of the recommended treatment pattern decreased with advancing disease severity (NYHA class IV: 21.1% application) and older age (≥90 years: 28.3% application).
Conclusions:
Family practitioners play a key role in the diagnosis and initial treatment of HF in Germany. A substantial proportion of patients do not receive guideline-recommended pharmacotherapy. These findings should be reflected in the planning of national disease management programmes.
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