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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
PubMed

Insights

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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