Work

Utilization patterns and determinants of guideline-recommended therapies for acute heart failure in Denmark

Year: 2025

Type: article

Abstract: AIMS: Acute heart failure (AHF) is a leading cause of frequent hospitalizations and poor outcomes. While chronic HF is treated with guideline-directed medical therapy, acute hospital care often requires loop diuretics, vasodilators, inotropes, and vasopressors. This study aimed to evaluate the inpatient use, dosing, and determinants of guideline-recommended therapies in patients hospitalized with AHF. METHODS AND RESULTS: This nationwide, register-based cohort study included 6009 patients aged ≥45 years hospitalized with AHF with a left ventricular ejection fraction (LVEF) of ≤40% in Denmark from 2018 to 2023. Data from the Danish Heart Failure Registry were linked to national healthcare registers. The main outcomes were inpatient use and doses of loop diuretics, vasodilators, inotropes, and vasopressors. Loop diuretics were used in 88.7% of patients [median dose (MD) of furosemide: 50 mg parenteral, 40 mg oral]. Vasodilators were administered to 36.1% (MD of nitroglycerine: 30 mg parenteral, 7.5 mg oral). Inotropes were administered to 3.0%, including dopamine (0.5%), dobutamine (1.0%), milrinone (0.9%), and levosimendan (1.1%). Vasopressors were used in 8.4%, with norepinephrine (7.3%) and epinephrine (2.0%). Older patients (≥75) had lower prevalence of vasodilator, inotrope, and vasopressor use. Severe HF (LVEF < 25%) was associated with lower prevalence of vasodilator and vasopressor use. In contrast, chronic kidney disease and recurrent HF hospitalization were linked to higher prevalence of use of all AHF therapies. CONCLUSION: Loop diuretics were widely used, while vasodilators, inotropes, and vasopressors had lower utilization. The observed variation in treatment reflects complexity of inpatient AHF management, warranting further studies to assess treatment outcomes.

Source: European Heart Journal Acute Cardiovascular Care

DOI: 10.1093/ehjacc/zuaf156

Authors: George Frederick Mkoma, Anders Hviid, Björn Pasternak, Henrik Svanström

Institutions: Statens Serum Institut, University of Copenhagen, Karolinska Institutet

Language: English

Topic: Heart Failure Treatment and Management

Subfield: Cardiology and Cardiovascular Medicine

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,792