Background
There is limited information on use of GDMT for heart failure (HF) across different phenotypes in clinical routine. To address this evidence gap, the non-interventional study (NIS) PRACTICE-HF Germany was designed to capture the current implementation of GDMT, associated treatment changes and adherence, and disease characteristics according to HF-phenotype, in a contemporary outpatient setting across 63 German cardiology practices.
Methods
Between 12/2023 and 07/2025, 913 individuals with worsening chronic or newly diagnosed HF were screened and 865 were enrolled. At baseline visit (BLV), two sets of data were collected: 1) patient- and disease characteristics along with existing HF prescription patterns (pre-BLV); 2) updated HF-related prescription patterns after BLV (post-BLV). This predefined interim analysis describes both data sets.
GDMT was defined according to current European Guidelines. For mildly reduced (HFmrEF) and reduced (HFrEF) left ventricular ejection fraction, GDMT was a 4-pillar approach encompassing SGLT2-inhibitors (SGLT2i), ARNI/ACE-inhibitors/ARB, MRA, and β-blockers. For preserved ejection fraction (HFpEF), GDMT was defined as SGLT2i plus management of HF related co-morbidities. Diuretics were recommended for all phenotypes as needed.
Results
At BLV, 39.6% of participants had HFrEF, 16.9% HFmrEF, and 43.5% HFpEF. De novo-HF was identified in 26% of HFrEF, 29.5% of HFmrEF, and 50.5% of HFpEF patients. Mean age was 72.5 years, 38.5% were female.
Pre-BLV, 22.7% of HFrEF participants received ≥4 HF-medications, yet only 7% received all 4 GDMTs. Post-BLV, the proportion prescribed all 4 GDMTs rose to 33.2%. Similarly, 21.2% of HFmrEF participants received ≥4 HF medications pre-BLV, with 3.4% receiving all 4 GDMTs. Post-BLV, 30.8% were prescribed all 4 GDMTs. Among HFpEF participants, 74.2% received ≥2 HF-medications pre-BLV, with 5.6% treated with SGLT2i and 46.3% with diuretics. Post-BLV, SGLT-2i prescription increased to 91.8% and diuretics to 55.9% in the HFpEF group.
In the overall study population β-blockers were prescribed most frequently pre-BLV and post-BLV (72.5% and 79.6%, respectively), followed by loop diuretics (33.6% and 40.9%). SGLT2i were most frequently applied post-BLV (89.5%), compared to a pre-BLV prescription rate of 19.5%.
Conclusions
There is significant variability in both pre- and post-BLV medication and adherence to guideline recommendations. Notably, in HFrEF and HFmrEF there is substantial potential to enhance GDMT, whereas the recommendation of SGLT2i treatment for HFpEF has promptly been adopted. The final analysis of this NIS will provide insights into prescription patterns 6-13 months after BLV.
