Utilization patterns and determinants of guideline-recommended therapies for acute heart failure in Denmark.

AIMS: Acute heart failure (AHF) is a leading cause of frequent hospitalizations and poor outcomes. While chronic HF is treated with guideline-directed medical therapy, acute hospital care often requires loop diuretics, vasodilators, inotropes, and vasopressors. This study aimed to evaluate the inpatient use, dosing, and determinants of guideline-recommended therapies in patients hospitalized with AHF.

METHODS AND

RESULTS

This nationwide, register-based cohort study included 6009 patients aged ≥45 years hospitalized with AHF with a left ventricular ejection fraction (LVEF) of ≤40% in Denmark from 2018 to 2023. Data from the Danish Heart Failure Registry were linked to national healthcare registers. The main outcomes were inpatient use and doses of loop diuretics, vasodilators, inotropes, and vasopressors. Loop diuretics were used in 88.7% of patients [median dose (MD) of furosemide: 50 mg parenteral, 40 mg oral]. Vasodilators were administered to 36.1% (MD of nitroglycerine: 30 mg parenteral, 7.5 mg oral). Inotropes were administered to 3.0%, including dopamine (0.5%), dobutamine (1.0%), milrinone (0.9%), and levosimendan (1.1%). Vasopressors were used in 8.4%, with norepinephrine (7.3%) and epinephrine (2.0%). Older patients (≥75) had lower prevalence of vasodilator, inotrope, and vasopressor use. Severe HF (LVEF < 25%) was associated with lower prevalence of vasodilator and vasopressor use. In contrast, chronic kidney disease and recurrent HF hospitalization were linked to higher prevalence of use of all AHF therapies.

CONCLUSION

Loop diuretics were widely used, while vasodilators, inotropes, and vasopressors had lower utilization. The observed variation in treatment reflects complexity of inpatient AHF management, warranting further studies to assess treatment outcomes.