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

Abstract

Aims: 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.

Methods: 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.

Results: 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%.

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

Keywords: Guideline-directed medical therapy; Health service research; Heart failure epidemiology & prognosis.