Patterns of Evidence-Based Medication Use in Older Adults with Chronic Heart Failure in Slovakia: A Population-Based Study Using the National Health Information Center Database.

backgroundPrescribing of evidence-based heart failure (HF) medications in older adults varies across settings, and population-level data from Central and Eastern Europe are scarce. Our study aimed to (a) evaluate the use of evidence-based medications among older adults with chronic HF and (b) identify patient- and healthcare-related characteristics associated with the use of evidence-based medications.

methodsIn our retrospective register-based study, all patients aged ≥ 65 years in whom at least one medication was prescribed in association with newly diagnosed HF during the period of 1 January 2016 to 31 December 2021 were included. Patients were divided into non-users, new users and prevalent users of evidence-based medications. Non-users were defined as patients who did not receive the specific medication class being analysed. New users were the patients in whom the use of such medications was initiated in association with the newly diagnosed HF without having a prescription for them during the previous 3 years. In prevalent users, these medications were used for diagnoses other than HF before inclusion in our study. Patient- and healthcare-related characteristics potentially associated with the use of evidence-based medications were evaluated with binary logistic regression models comparing the group of new users with non-users.

resultsThe following proportions of users (both new and prevalent) were observed in our study group of 111,774 patients: angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers/angiotensin receptor-neprilysin inhibitor were prescribed in 78.5% (95% confidence interval [CI] 78.3-78.8), β-blockers in 76.2% (95% CI 75.9-76.4), mineralocorticoid receptor antagonists in 41.1% (95% CI 40.8-41.4), digoxin in 13.5% (95% CI 13.3-13.7), ivabradine in 3.8% (95% CI 3.7-3.9) and sodium-glucose cotransporter-2 (SGLT2) inhibitors in 3.7% (95% CI 3.6-3.8) of patients. Specialisation of the physicians in internal medicine/cardiology, or in diabetology in the case of SGLT2 inhibitors, showed the strongest association with the prescription of analysed medications. Comorbidities were associated with the use of evaluated medications when they constituted indications or contraindications for their administration.

conclusionAmong older adults with HF, the prescription of evidence-based medications was strongly associated with physician specialty, reflecting the importance of specialised expertise in the management of HF.