Understanding Patient Demographics, Treatment Pathways, and Physician Prescribing Behavior

How is Chronic Heart Failure Treated Today?

Chronic heart failure (CHF) is a serious cardiovascular (CV) syndrome affecting millions of people in the United States alone. For years, treatment was dominated by highly genericized drug classes targeting various aspects of the CHF syndrome. But now, new thinking about CHF and several novel treatments have begun to shift treatment practice. The availability of Novartis’s Entresto (sacubitril/valsartan) and Amgen’s Corlanor (ivabradine) has altered the dynamics of the CHF market. Additionally, the clinical distinction of patients with preserved ejection fraction (HFpEF) from patients with reduced ejection fraction (HFrEF) has also required new thinking from medical practitioners, academics, and drug developers since no treatment has yet demonstrated benefits in this large subset of patients. As the few branded agents jostle for patient share in this crowded sector, and with several promising therapies on the horizon, any positive change in practice and perceptions for such a prevalent indication can translate into significant commercial success.

Who are Chronic Heart Failure patients?

Different patients need different drugs and in this age of therapy individualization, patient demographics for CHF brands can shed light on drug uptake and utilization. Laboratory tests, risk factors, comorbidities, concomitant medications, consulted physicians, and insurance coverage all help build the CHF patient profile.

The representative Entresto patient is male, age 65, with a mean weight of 93kg.

Source: DRG. Current Treatment: Patient Profiler: Chronic Heart Failure (US). June 2018.

What are Chronic Heart Failure patients being prescribed?

Despite the effectiveness of novel agents (such as Entresto and Corlanor), the mainstays of current treatment are highly genericized beta blockers, loop diuretics, and ACE inhibitors. The diverse range of available CHF treatments makes for a complicated and dynamic treatment paradigm, where prescription trends and compliance information can be vital for competitive positioning.

Source: DRG. Current Treatment: Treatment Algorithm: Chronic Heart Failure (US). March 2018.

Healthcare providers and drug developers increasingly appreciate the distinction between patients with heart failure and reduced ejection fraction (HFrEF) and those with preserved ejection fraction (HFpEF). Broadly speaking, HFrEF patients appear to be treated more aggressively than HFpEF patients, as evidenced by the greater use of combination therapy across various lines of treatments. However, with no medications approved for HFpEF, and current treatment based on patient symptoms, therapeutic approaches are constantly evolving for this population.

Source: DRG. Current Treatment: Treatment Algorithm: Chronic Heart Failure – Reduced Ejection Fraction (US). March 2018.

Source: DRG. Current Treatment: Treatment Algorithm: Chronic Heart Failure – Preserved Ejection Fraction (US). April 2018.

What factors drive physician prescribing for Chronic Heart Failure treatment?

Physicians have numerous therapeutic options available, both new and old. But what are the factors driving prescribing for CHF? Our research indicates that hard CV outcomes, including reductions in mortality and hospitalizations, are the most important clinical factors guiding physicians’ decisions in the case of both surveyed cardiologists and PCPs. Non-clinical factors, particularly those associated with costs and convenience, are stronger drivers for PCPs than cardiologists. The efficacy, safety, and affordability of CHF current treatments also influence prescribers to varying degrees.

Importance of Clinical Factors in Choice of Treatment for CHF

Importance of Nonclinical Factors in Choice of Treatment for CHF

Source: DRG. Current Treatment: Physician Insights: Chronic Heart Failure (US). May 2018.

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