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[Heart failure in Germany: epidemiology and recent developments]
Josefine Rudolph1, Stephan von Haehling1,2
1Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Göttingen.
Deutsche Medizinische Wochenschrift (1946)
|October 28, 2025
Summary
Heart failure management in Germany involves four key drug classes, but these treatments can cause electrolyte imbalances like hypo- or hyperkalemia and iron deficiency. Vigilant monitoring for these complications is crucial for patient safety.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Heart failure with reduced ejection fraction (HFrEF) is a leading cause of hospitalization in Germany, imposing significant burdens.
- Current evidence-based HFrEF management since 2021 relies on four pharmacological pillars: beta-blockers, sacubitril/valsartan (or ACE inhibitors), mineralocorticoid-receptor antagonists, and SGLT-2 inhibitors.
- These essential therapies, while improving outcomes, are associated with adverse effects, particularly electrolyte disturbances and iron deficiency.
Purpose of the Study:
- To review recent epidemiological data on heart failure in Germany and Europe.
- To outline current guideline-directed medical therapies for HFrEF.
- To highlight critical treatment-related complications requiring clinical management.
Main Methods:
- Literature review of recent epidemiological data for heart failure.
- Summary of current guideline-directed therapies for HFrEF.
- Identification and discussion of key treatment-related complications.
Main Results:
- Heart failure remains a primary cause of hospitalization, necessitating careful management.
- The four pillars of HFrEF therapy can lead to hypo- or hyperkalemia, increasing arrhythmia risk.
- Iron deficiency is common in HFrEF patients, with intravenous iron preparations being tested for correction.
Conclusions:
- Effective HFrEF management requires balancing therapeutic benefits with potential adverse effects.
- Vigilant monitoring for electrolyte disturbances (hypo-/hyperkalemia) and iron deficiency is essential.
- Clinicians must be prepared to anticipate and manage these treatment-related complications.
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