Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2022, 166(3):322-327 | DOI: 10.5507/bp.2021.035

Angiotensin-converting enzyme inhibitors, angiotensin-II-receptor antagonists and angiotensin-receptor blocker/neprilysin inhibitor utilization in heart failure patients: Sub-analysis of a nation-wide population-based study in the Czech Republic

Renata Aiglova^a, Milos Taborsky^a, Marie Lazarova^a, Ludek Pavlu^a, Josef Danek^b, Jan Precek^a, Alexander Schee^c, Vit Gloger^d, Vlastimil Cernicek^d, Marek Vicha^a, Tomas Skala^a

^a Department of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic

^b Department of Internal Medicine, Military University Hospital Prague, Prague, Czech Republic

^c Cardio center, Regional Hospital Karlovy Vary, Karlovy Vary, Czech Republic

^d Bata's Regional Hospital, Zlin, Czech Republic

Aims: Sub-analysis of a retrospective nation-wide observational analysis of heart failure (HF) epidemiology reported to the Czech National Registry of Reimbursed Health Services between 2012 and 2018 aimed at angiotensin-converting enzyme inhibitors (ACEI), angiotensin-II-receptor antagonists (ARB) and angiotensin receptor blocker/neprilysin inhibitor (ARNI) use.

Methods and Results: ACEi and ARBs were generally used in 87.6% of all HF patients in 2012 (n=154 627); 84.5% in 2013 (n=170 861); 83.5% in 2014 (n=186 963); 81.6% in 2015 (n=198 844); 80.1% in 2016 (n=205 793); 78.0% in 2017 (n=212 152) and in 76.7% in 2018 (n=219 235). In a sub-analysis of patients with a medical procedure and/or examination using an I50.x ICD code accounted for in the given year, ACEi and ARBs were generally used in 99.3% in 2012 (n=63 250); 96% in 2013 (n=62 241); 95.2% in 2014 (n=64 414); 93.3% in 2015 (n=65 217); 91.8% in 2016 (n=65 236); 90.1% in 2017 (n=65 761) and in 88.6% in 2018 (n=66 332). In 2018, the majority of patients with HF were prescribed ramipril (n=49 909; 17.5%) and perindopril (n=44 332; 15.5%). The mostly prescribed ARBs in 2018 were telmisartan (n=18 669; 6.5%); losartan (n=13 935; 4.9%) and valsartan (n=4 849; 1.7%). In 24.5% of cases, ACEIs and ARBs were prescribed in a fixed combination with another drug. ARNI became gradually more prescribed from 2018 (n=9 659 in November 2020).

Conclusion: In an analysis of ACEIs, ARBs and ARNIs utilization in all patients treated for heart failure in the given year in the whole country, we found a comparable rate of drug prescription in comparison with specific heart failure registries. This indicates a good translation of current standard of care into common clinical practice. Ramipril and perindopril remained the mostly prescribed ACEIs and telmisartan became the mostly prescribed ARB. Since 2018, ARNIs began to be widely prescribed.

Keywords: angiotensin-converting enzyme (ACE) inhibitors, angiotensin-II-receptor antagonists, sacubitril/valsartan, heart failure, European Union, Czech Republic

Received: January 3, 2021; Revised: May 21, 2021; Accepted: May 28, 2021; Prepublished online: June 4, 2021; Published: September 14, 2022  Show citation