PMID- 28748266
OWN - NLM
STAT- MEDLINE
DCOM- 20180831
LR  - 20181113
IS  - 1861-0692 (Electronic)
IS  - 1861-0684 (Print)
IS  - 1861-0684 (Linking)
VI  - 106
IP  - 11
DP  - 2017 Nov
TI  - Treatment of chronic heart failure in Germany: a retrospective database study.
PG  - 923-932
LID - 10.1007/s00392-017-1138-6 [doi]
AB  - BACKGROUND: Adherence to treatment guidelines affects outcomes in patients with 
      chronic heart failure (HF). We investigated patient pathways and treatment 
      patterns for HF in Germany. METHODS: This 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. RESULTS: Of 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). 
      CONCLUSIONS: Family 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.
FAU - Stork, Stefan
AU  - Stork S
AD  - Comprehensive Heart Failure Centre Wurzburg and Department of Internal Medicine 
      I, University and University Hospital Wurzburg, Am Schwarzenberg 15, 97078, 
      Wurzburg, Germany. Stoerk_S@ukw.de.
FAU - Handrock, Renate
AU  - Handrock R
AD  - Novartis Pharma GmbH, Nuremberg, Germany.
FAU - Jacob, Josephine
AU  - Jacob J
AD  - Elsevier Health Analytics, Berlin, Germany.
AD  - Health Risk Institute, Berlin, Germany.
FAU - Walker, Jochen
AU  - Walker J
AD  - Elsevier Health Analytics, Berlin, Germany.
AD  - Health Risk Institute, Berlin, Germany.
FAU - Calado, Frederico
AU  - Calado F
AD  - Novartis Pharma AG, Basel, Switzerland.
FAU - Lahoz, Raquel
AU  - Lahoz R
AD  - Novartis Pharma AG, Basel, Switzerland.
FAU - Hupfer, Stephan
AU  - Hupfer S
AD  - Novartis Pharma GmbH, Nuremberg, Germany.
FAU - Klebs, Sven
AU  - Klebs S
AD  - Novartis Pharma GmbH, Nuremberg, Germany.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20170726
PL  - Germany
TA  - Clin Res Cardiol
JT  - Clinical research in cardiology : official journal of the German Cardiac Society
JID - 101264123
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Cardiology/*standards
MH  - Databases, Factual
MH  - *Disease Management
MH  - Female
MH  - Germany/epidemiology
MH  - *Guideline Adherence
MH  - Heart Failure/epidemiology/*therapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Morbidity/trends
MH  - Retrospective Studies
MH  - Treatment Outcome
PMC - PMC5655600
OTO - NOTNLM
OT  - Cardiologist
OT  - Care pathway
OT  - Germany
OT  - Guidelines
OT  - Heart failure
OT  - Treatment pattern
COIS- ETHICAL STANDARDS: This study was conducted in accordance with the Guidelines for 
      Good Pharmacoepidemiology Practices of the International Society for 
      Pharmacoepidemiology (2008), the Strengthening the Reporting of Observational 
      Studies in Epidemiology guidelines (2008), and with the ethical principles laid 
      down in the Declaration of Helsinki. CONFLICT OF INTEREST: Stefan Stork receives 
      funding from the German Federal Ministry of Education and Research (01EO1004 and 
      01EO1504) and has received honoraria from Bayer, Boehringer Ingelheim, Novartis, 
      and Servier. Renate Handrock, Stephan Hupfer, and Sven Klebs are employees of 
      Novartis Pharma GmbH. Josephine Jacob and Jochen Walker were employees of 
      Elsevier Health Analytics at the time of the study and were consultants for 
      Novartis. Frederico Calado and Raquel Lahoz are employees of Novartis Pharma AG. 
      FUNDING: This study was funded by Novartis Pharma AG. Data analysis was performed 
      by Elsevier Health Analytics in coordination with the Health Risk Institute (both 
      Berlin, Germany).
EDAT- 2017/07/28 06:00
MHDA- 2018/09/01 06:00
PMCR- 2017/07/26
CRDT- 2017/07/28 06:00
PHST- 2017/04/21 00:00 [received]
PHST- 2017/07/17 00:00 [accepted]
PHST- 2017/07/28 06:00 [pubmed]
PHST- 2018/09/01 06:00 [medline]
PHST- 2017/07/28 06:00 [entrez]
PHST- 2017/07/26 00:00 [pmc-release]
AID - 10.1007/s00392-017-1138-6 [pii]
AID - 1138 [pii]
AID - 10.1007/s00392-017-1138-6 [doi]
PST - ppublish
SO  - Clin Res Cardiol. 2017 Nov;106(11):923-932. doi: 10.1007/s00392-017-1138-6. Epub 
      2017 Jul 26.