Prevalence of heart failure phenotypes and current use of therapies in primary care: results from a nationwide study.

AIMS: Heart failure (HF) is an increasing concern worldwide. A rising HF burden is expected due to the prospected future demographic changes with aging populations. Consequently, the long-term follow-up and treatment will be performed increasingly by primary care physicians in the future. Contemporary data on HF patients in primary care are needed to plan and ensure an effective and safe follow-up of future patients. METHODS AND RESULTS: The electronic patient journals of 148 primary care clinics in Denmark were searched in a standardized manner to identify patients with HF [code K77 of the International Classification of Primary Care, Second Edition]. Prespecified variables including demographic information, clinical variables, co-morbidities, prescribed medications, and setting of follow-up were recorded. In total, 1111 patients were included in the study. The mean timepoint for the HF diagnosis was August 2018. In 95% of cases, the diagnosis of HF was made in a specialized setting. The echocardiogram data used for phenotyping were available in 1042 (94%) of the 1111 patients. HF with reduced ejection fraction (HFrEF) was present in 43%, recovered HFrEF in 31%, and HF with mildly reduced (HFmrEF) or preserved ejection fraction (HFpEF) in 26%. In patients with HFrEF or recovered HFrEF, fundamental treatments were prescribed in 86% for angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), or angiotensin receptor neprilysin inhibitor (ARNI), in 82% for beta-blocker, in 38% for mineralocorticoid receptor antagonist (MRA), and in 12% for sodium-glucose co-transporter-2 inhibitor (SGLT2i). Older patients were treated to a significantly lesser extent than young patients for all drug classes [odds ratio (OR) point estimates 0.50 to 0.69, all P-values < 0.05]. In patients with HFmrEF or HFpEF, an ACEI, ARB, or ARNI was prescribed in 67%, beta-blocker in 67%, MRA in 22%, and SGLT2i in 7.4% with significantly lower probability of treatment compared to patients with HFrEF or recovered HFrEF [OR point estimates 0.33 to 0.57, all P-values < 0.05]. The setting of follow-up was available in 96% of patients. Irrespective of HF phenotype, follow-up was performed solely in primary care in 64%. These patients were generally treated to a lesser extent with HF therapies compared with patients where follow-up included specialized care, yet differences were generally small. CONCLUSIONS: HFrEF is the most common phenotype of HF in primary care followed by recovered HFrEF and fundamental therapies are markedly underutilized. Initiatives to increase the use of recommended therapies are needed to improve the future care of patients with HF.

Management of patients with chronic obstructive lung disease, Type 2 diabetes and both diseases in primary care in Denmark.

INTRODUCTION: We studied the implementation of recommended yearly control visits, quality of care and characteristics and co-morbidities of patients with chronic obstructive lung disease (COPD), Type 2 diabetes mellitus (T2DM) and those with both conditions in a sample of Danish general practices. METHODS: This was a retrospective audit of patient records from 2017 in 164 general practices in Denmark. Up to 15 patients were randomly selected in each practice for assessment of relevant parameters and quality of care, producing a total of 820 patients with COPD, 823 patients with T2DM and 709 patients with both COPD and T2DM. RESULTS: Formalised annual control visits were completed in 72% of the patients with T2DM and 48% of the patients with COPD. Approximately 13% of the patients were followed by a specialist. Patients with both diseases had the highest number of healthcare contacts but the lowest fulfilment of annual control visits. The standard of care was fair, although assessment of the disease characteristics of COPD was less complete in patients with both conditions. Cardiovascular diseases including heart failure were significantly more common in patients with both conditions (42%) than in those with COPD only (29%) or T2DM only (27%). CONCLUSIONS: In 2017, the implementation of annual control visits for COPD was less complete than for T2DM. Patients with both diseases had the highest prevalence of cardiovascular disease and use of health resources, suggesting that this group needs additional attention. FUNDING: The present study was sponsored by Boehringer Ingelheim Denmark. TRIAL REGISTRATION: not relevant.