Aims To analyse real‐world treatment patterns of sacubitril/valsartan (sac/val) using data from a pharmacy database in Germany. Methods and results A retrospective cohort study of 26 191 adult patients (aged ≥ 18 years) in the IMS® longitudinal prescriptions database in Germany who were dispensed sac/val from January 2016 to June 2017 was conducted. The analysis included sac/val dose titration assessed in the 6 months from first sac/val prescription; prescriptions of concomitant cardiovascular medications in the 6 months pre‐ and post‐index and compliance and persistence during 12 months post‐index. Two‐thirds of patients were prescribed the lowest sac/val dose of 50 mg twice daily (b.i.d.) at index and up‐titration during the first 6 months was attempted in 41% of these patients. Ten percent of patients prescribed 200 mg b.i.d. at index had to be stably down‐titrated; among patients prescribed 50 or 100 mg b.i.d. at index that were up‐titrated, > 80% remained on the higher dose. Overall, the mean daily diuretic dose decreased by 25% after initiation of sac/val. High compliance and persistence rates were observed across sac/val doses, increasing with higher sac/val dose at index. Prior dose of angiotensin‐converting enzyme inhibitor or angiotensin receptor blocker had only minor impact on first sac/val dose, compliance and persistence. Conclusions Most patients prescribed sac/val are not initiated on the recommended dose nor up‐titrated as recommended by the EU Summary of Product Characteristics. Initiation of sac/val was associated with high persistence and compliance and a dose reduction of diuretics. Barriers to up‐titration must be explored.

IntroductionThe objective of this study was to evaluate real-world treatment patterns of type 2 diabetes (T2D) patients initiating glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in Germany (GE), the United Kingdom (UK), France (FR), the Netherlands (NE), Belgium (BE), and Sweden (SE).MethodsAdult T2D patients initiating exenatide twice daily (exBID), liraglutide once daily (LIRA) or exenatide once weekly (exQW) were identified using the IMS LifeLink™ (IMS Health, Danbury, CT, USA): Electronic Medical Records (EMR; GE/UK/FR) and IMS LifeLink™: longitudinal prescriptions (LRx; NE/BE/GE/UK) databases, and national health register data (SE), between 2010 and 2012. Therapy initiation date was termed ‘index date’. Eligible patients had ≥180-day pre- and variable follow-up (minimum ≥360-day post-index exBID and LIRA, ≥180-day post-index exQW). Treatment modification and persistence were evaluated over 180 days. Kaplan–Meier (KM) survival curves and Cox proportional hazards models (PHMs; EMR databases only) evaluated stopping of the index therapy (measured as first of discontinuation or switch).Results30,206 exBID, 5,401 exQW, and 52,155 LIRA patients were included in the analysis (46.0–66.9% male; mean age range 55.4–59.3 years). Mean follow-up was 20.3–27.4 months for exBID and LIRA, and 7.6–13.9 months for exQW. Across the databases, the proportion experiencing a treatment modification at 180 days was highest among exBID (37.6–81.7%) compared to LIRA (36.8–56.6%) and exQW (32.3–47.7%). The proportion persistent at 180 days was lowest among exBID patients (46.8–73.5%) compared to LIRA (50.6–80.1%) or exQW (57.5–74.6%). In the KM analyses, LIRA patients had a lower proportion stopping therapy at all time points compared to exBID patients, across the databases. In the Cox PHMs, LIRA was associated with a significantly lower risk of stopping compared to exBID; in GE, exQW was associated with a lower risk compared to exBID and LIRA.ConclusionTreatment patterns varied among GLP-1 RA patients, with persistence highest among either LIRA or exQW across countries, and lowest among exBID. Longer-term data would be useful, particularly given limited exQW follow-up due to more recent launch.Electronic supplementary materialThe online version of this article (doi:10.1007/s13300-014-0087-6) contains supplementary material, which is available to authorized users.

PurposeThe purpose of this study was to examine the trends in heart failure (HF) epidemiology and diagnostic work-up in Sweden.MethodsAdults with incident HF (≥2 ICD-10 diagnostic codes) were identified from linked national health registers (cohort 1, 2005–2013) and electronic medical records (cohort 2, 2010–2015; primary/secondary care patients from Uppsala and Västerbotten). Trends in annual HF incidence rate and prevalence, risk of all-cause and cardiovascular disease (CVD)-related 1-year mortality and use of diagnostic tests 6 months before and after first HF diagnosis (cohort 2) were assessed.ResultsBaseline demographic and clinical characteristics were similar for cohort 1 (N=174,537) and 2 (N=8,702), with mean ages of 77.4 and 76.6 years, respectively; almost 30% of patients were aged ≥85 years. From 2010 to 2014, age-adjusted annual incidence rate of HF/1,000 inhabitants decreased (from 3.20 to 2.91, cohort 1; from 4.34 to 3.33, cohort 2), while age-adjusted prevalence increased (from 1.61% to 1.72% and from 2.15% to 2.18%, respectively). Age-adjusted 1-year all-cause and CVD-related mortality was higher in men than in women among patients in cohort 1 (all-cause mortality hazard ratio [HR] men vs women 1.07 [95% CI 1.06–1.09] and CVD-related mortality subdistribution HR for men vs women 1.04 [95% CI 1.02–1.07], respectively). While 83.5% of patients underwent N-terminal pro-B-type natriuretic peptide testing, only 36.4% of patients had an echocardiogram at the time of diagnosis, although this increased overtime. In the national prevalent HF population (patients with a diagnosis in 1997–2004 who survived into the analysis period; N=273,999), death from ischemic heart disease and myocardial infarction declined between 2005 and 2013, while death from HF and atrial fibrillation/flutter increased (P<0.0001 for trends over time).ConclusionThe annual incidence rate of HF declined over time, while prevalence of HF has increased, suggesting that patients with HF were surviving longer over time. Our study confirms that previously reported epidemiological trends persist and remain to ensure proper diagnostic evaluation and management of patients with HF.

PurposeLittle evidence exists on the burden that chronic heart failure (HF) poses specifically to patients in China. The objective of this study, therefore, was to describe the burden of HF on patients in China.Materials and methodsA cross-sectional survey of cardiologists and their patients with HF was conducted. Patient record forms were completed by 150 cardiologists for 10 consecutive patients. Patients for whom a patient record form was completed were invited to complete a patient questionnaire.ResultsMost of the 933 patients (mean [SD] age 65.8 [10.2] years; 55% male; 80% retired) included in the study received care in tier 2 and 3 hospitals in large cities. Patients gave a median score of 4 on a scale from 1 (no disruption) to 10 (severe disruption) to describe how much HF disrupts their everyday life. Patients in paid employment (8%) missed 10% of work time and experienced 29% impairment in their ability to work due to HF in the previous week. All aspects of patients’ health-related quality of life (QoL) were negatively affected by their condition. Mean ± SD utility calculated by the 3-level 5-dimension EuroQol questionnaire was 0.8±0.2, and patients rated their health at 70.3 (11.5) on a 100 mm visual analog scale. Patients incurred costs associated with HF treatment, travel, and professional caregiving services.ConclusionHF is associated with poor health-related QoL and considerable disruption in patients’ lives. Novel and improved therapies are needed to reduce the burden of HF on patients and the health care system.

PurposeFamily and friends play a pivotal role in caring for patients with heart failure (HF); however, evidence of the impact of caregiving is limited. The objectives of this study were to describe the burden of caregiving on informal caregivers of patients with chronic HF in China.Materials and methodsA cross-sectional survey of cardiologists, their patients with HF, and those patients’ caregivers was conducted. Patient record forms were completed by 150 cardiologists for 10 consecutive patients. Caregivers of these patients were invited to complete a questionnaire.ResultsOverall, 458 caregivers completed a questionnaire (mean ± standard deviation age 60.1±10.6 years; 60% female; 77% spouses; 74% retired). Caregivers spent a mean of 24.5 (16.9) hours caregiving per week, and a third reported a reduction in their social activity, time for themselves, or time for family. Caregivers in employment took several days off work in the past 3 months owing to caregiving, sometimes resulting in reduced income. Up to 79% of caregivers reported an impact on their physical or emotional well-being, and 57% reported deterioration in their objective health status. Inconsistencies stemming from differences in the three-level five-dimension EuroQol questionnaire and HF Caregiver Questionnaire were observed for the impact of caregiving on caregivers’ health-related quality of life.ConclusionAssisting patients with HF is associated with caregiver burden. Addressing the needs of caregivers may help to promote their continued support and improve patient outcomes.