Real-world prescription patterns of guideline-recommended therapies in heart failure across China.

Comprehensive real-world studies on guideline-recommended therapies for heart failure (HF) in China are lacking. This study aimed to describe the prescription patterns of guideline-recommended therapies and identify factors influencing sodium-glucose co-transporter 2 inhibitors (SGLT2 inhibitors) use in a nationwide patient cohort. We analyzed prescriptions from HF patients across 134 hospitals in nine Chinese cities (January 2018 to June 2023). Prescription trends for core guideline-recommended HF medication classes were assessed, and multivariable logistic regression identified factors associated with SGLT2 inhibitors use. Among 1,852,053 HF patients (median age 71; 58.35% male), β-blockers and MRAs use remained stable over time. ARNI utilization increased, correspondingly reducing ACEI/ARB use. SGLT2 inhibitors use rose significantly from 2020. Factors positively associated with SGLT2 inhibitors use included male sex (OR 1.34, 95% CI 1.31-1.36), age 18-59 years, treatment in tertiary hospitals, and diagnoses of atrial fibrillation (OR 1.34, 95% CI 1.31-1.38), dyslipidemia (OR 1.57, 95% CI 1.52-1.61), or diabetes (OR 6.28, 95% CI 6.15-6.41). This first large-scale, multicenter retrospective analysis delineates real-world HF medication usage patterns in China. The findings reveal a progressive uptake of newer therapies such as SGLT2 inhibitors, with prescription rates increasing substantially following guideline updates. SGLT2 inhibitors use, while consistent with recent evidence, is influenced by demographic, clinical, and systemic factors, indicating significant potential for optimization to maximize clinical benefits.