Heart failure prevalence and incidence in Germany: National data on medical therapy and comorbidities

Heart failure (HF) is linked to high mortality, morbidity and reduced quality of life. Despite available guideline-directed medical treatment (GDMT), underdiagnosis and undertreatment remain unsolved challenges. Ambulatory real-world data from Germany are scarce.

We analyzed outpatient claims and prescription data from approximately 74.3 million statutorily health insured (SHI) Germans between 2015 and 2023. HF prevalence and comorbidities were identified in patients with ≥2 HF diagnoses and ≥ 1 relevant comorbidity documentation within one year. Utilization of outpatient drug therapy was assessed in newly diagnosed cases from the first of ≥2 HF diagnoses, followed over four subsequent quarters.

Outpatient HF prevalence ranged about 2.2 million patients annually (3.5-3.8%), increasing sharply with age (>90 years: 27.6%) and the median annual HF incidence was 364,446 (0.61%) of 60,838,679 SHI patients. Within the HF prevalent cohort, common risk factors included arterial hypertension (90.0%), dyslipidemia (56.4%) and coronary artery disease (52.1%). HF diagnosis was primarily coded by general practitioners (69%), followed by outpatient cardiologists (23.6%). In incident HF patients prescription rates included angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (59.3%), beta-blockers (55.9%), diuretics (44.3%), mineralocorticoid antagonists (15.7%), glycosides (4.7%), angiotensin-receptor-neprilysin-inhibitor (ARNI, 4.1%) and sodium-glucose cotransporter-2 (SGLT2) inhibitors (3.3%). ARNI and SGLT2i prescriptions peaked at 9.4% and 17.6% in 2022, reflecting their recent introduction in the HF treatment guidelines as well as four-pillar therapy with 12.5%.

National ambulatory data highlight the critical role of general practitioners in HF care and support a rising trend in GDMT use in Germany.