Purpose: To explore the use of angiotensin-converting-enzyme-inhibitors (ACEis) and angiotensin-receptor-blockers (ARBs) in patients with symptomatic left ventricular HF. For patients with HF with reduced ejection fraction (rEF) these drug classes are recommended by guidelines.

Methods: Analyses were performed on the HRI database. This database consists of a complete, longitudinal claims data set of 7 million anonymized individual patients between 2010 and 2015. To allow extrapolation to the total number of patients in the German Statutory Health Insurance (SHI) population, an analysis subset (ca. 4.0 million anonymized patients) has been used. This comprises a stratified sample matching the German population in terms of age and gender. For extrapolation to the overall population in GER the regional distribution of insurants was considered. ICD-10 codes were used to identify patients with symptomatic left ventricular HF (I50.11 - I50.14) which had to be documented in the ambulatory (≥ 2 confirmed diagnoses) or hospital setting (≥ 1 diagnosis at discharge) in 2015. Anatomical Therapeutic Chemical codes were used to identify treatment with ACEis or ARBs. Only drugs formally approved for the treatment of HF were considered (e.g. fixed-dose combinations of ACEis or ARBs with diuretics not). Analyses were performed based on gender, age, and New York Heart Association (NYHA) classes also considering diabetes mellitus as a relevant cardiovascular comorbidity.           

Results: Approximately two third of the patients in the populations analyzed received treatment with ACEis or ARBs (table 1). ACEis were used in the majority of the patients (43-51%), ARBs in 14-20%. Use of these drug classes was slightly lower in women as well as in younger patients (20-49 years old) and very elderly patients (80 years and older). Treatment was similar across the different NYHA classes. In diabetics, use was slightly higher compared with non-diabetics.

Conclusion: The majority of SHI patients received treatment with ACEis or ARBs. Additional analyses may be needed to further evaluate the lower treatment rates observed in women, younger patients and very elderly. A relevant limitation is the use of ICD-10 codes to identify the patients, which do not allow differentiation between HF with preserved and rEF. Moreover, only drugs formally approved for the treatment of HF were considered. Thus, the proportion observed may represent an underestimation for the patient proportion with symptomatic HF with rEF where ACEis or ARBs (in ACEi-intolerant patients) are indicated according to treatment guidelines.

Table 1: Patient proportions [%] in the German SHI treated with ACEis, ARBs and in total

NYHA: New York Heart Association; N: Number