Abstract
BackgroundAdherence to treatment guidelines affects outcomes in patients with chronic heart failure (HF). We investigated patient pathways and treatment patterns for HF in Germany.MethodsThis retrospective study used anonymous healthcare claims data from the German Health Risk Institute on individuals with statutory health insurance. Patients with uninterrupted data from 1 January 2009 to 31 December 2013 or death (whichever occurred first), and ≥2 recorded HF-related diagnoses in 2011, were included. Patients with newly diagnosed HF were identified. Use of treatment patterns recommended by the European Society of Cardiology (2008) and German Nationale VersorgungsLeitlinien (2011) guidelines was evaluated.ResultsOf 123,925 patients with HF, 21.3% were newly diagnosed. Overall, 63.2% of new HF diagnoses were made in the ambulatory setting; 61.6% of these were made by family practitioners and 14.8% by cardiologists. In the ambulatory setting, family practitioners were primarily responsible for treatment; specialists in internal medicine (70.3% cardiologists) were mainly responsible for performing HF-related technical diagnostics. One-fifth (20.9%) of patients received a New York Heart Association (NYHA) classification; 45.1% of these received a guideline-based treatment pattern. Application of the recommended treatment pattern decreased with advancing disease severity (NYHA class IV: 21.1% application) and older age (≥90 years: 28.3% application).ConclusionsFamily practitioners play a key role in the diagnosis and initial treatment of HF in Germany. A substantial proportion of patients do not receive guideline-recommended pharmacotherapy. These findings should be reflected in the planning of national disease management programmes.
Highlights
In Germany, medical care for patients with chronic heart failure (HF) is provided by various healthcare professionals in different healthcare sectors, including hospital-based cardiologists, office-based cardiologists, and/ or general practitioners (GPs) [1]
Variations may arise owing to the characteristics of patients per setting [10, 11]; for example, patients with severe HF and acute decompensation are more likely to be admitted to hospital, while elderly patients and individuals with less severe HF are frequently treated by GPs in collaboration with an officebased cardiologist [12]
Of diagnoses made in the ambulatory setting, the majority (61.6%) were made by family practitioners
Summary
In Germany, medical care for patients with chronic heart failure (HF) is provided by various healthcare professionals in different healthcare sectors, including hospital-based cardiologists, office-based cardiologists, and/ or general practitioners (GPs) [1]. The availability of diagnostic tools differs between settings; for example, because GPs are usually not reimbursed for performing echocardiography [8] they rarely use this tool; echocardiography is used regularly by office-based cardiologists and hospitalbased physicians [9]. Use of treatment patterns recommended by the European Society of Cardiology (2008) and German Nationale VersorgungsLeitlinien (2011) guidelines was evaluated. 63.2% of new HF diagnoses were made in the ambulatory setting; 61.6% of these were made by family practitioners and 14.8% by cardiologists.
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