Acute heart failure (AHF) is one of the leading causes of hospitalization in the United States, representing a significant healthcare burden. AHF patients experience high rates of mortality and morbidity. These rates have not changed significantly in recent years because none of the currently approved AHF therapies have been able to improve clinical outcomes. Therefore, the main focus of current treatment of AHF remains symptomatic relief. This content shows how AHF is currently being treated and what drives the choice of pharmacotherapy for AHF patients. We reveal how and when AHF agents are being used, from the initiation of therapy, typically with loop diuretics, through to further lines of treatment. We unravel how pharmacotherapy choices are dictated by patient characteristics given the heterogeneity of symptoms in AHF.

Questions answered:

  • Which drugs are most-commonly used to treat AHF patients, and how does treatment change based on patient characteristics?
  • What are the typical treatment patterns for AHF patients, which drugs are prescribed in each treatment line, and what triggers the switch to the next line of treatment?
  • Do treatment approaches differ between patients with acutely decompensated HF and de novo AHF?
  • What are the cardiologist-reported factors determining current prescribing patterns for AHF and recent/anticipated changes?

Scope:

Markets covered: United States

Methodology: Survey of 101 cardiologists in the United States, completed in February 2017

Indication coverage: Acute heart failure

Key drugs covered: Inotropic sympathomimetics, loop diuretics, Natrecor, nitrate vasodilators, PDE3 inhibitors

Key companies mentioned: Cardiorentis, Janssen, Novartis, Sanofi, Valeant

Table of contents

  • Heart Failure - Current Treatment - Detailed, Expanded Analysis Acute Heart Failure (US)
    • Key updates
      • November 2017
        • August 2017
          • Expert Analysis: Trends in the Prescribing of Oral CHF Therapies Following an AHF Event
      • Introduction to Current Treatment for Acute Heart Failure
        • Key Findings
        • Summary Figures
          • Patient Share of Acute Heart Failure Drug Classes
          • Product Patient Share by Line of Therapy
        • Introduction to Current Treatment and Medical Practice for Acute Heart Failure
        • Drugs Included in This Study of Current Treatment of Acute Heart Failure
      • Physician Prescribing Practices
        • Key Findings
        • Patient Characteristics
          • Acute Heart Failure Patients Are a Heterogeneous Population
          • Hospital Ward Where Acute Heart Failure Patients Typically Present and Where Treatment Is Initiated
          • Type of Physician Who Typically Diagnoses Acute Heart Failure
          • Level of Blood Pressure in Acute Heart Failure Patients
          • Characteristics of Acute Heart Failure Patients
          • Prevalence of Comorbidities Among Acute Heart Failure Patients
          • Most Common Factors Triggering Acute Heart Failure
          • Average Length of Hospital Stay for De Novo Acute Heart Failure and Acute Decompensated Heart Failure
          • Percentage of Patients with De Novo Acute Heart Failure and Acute Decompensated Heart Failure Requiring Rehospitalization for Heart Failure Within One Year After Discharge
          • Acute Heart Failure Mortality Rates
        • Treatment Practices
          • The Treatment Approach in Acute Heart Failure Is Tailored to Patient Characteristics
          • Treatment Is Initiated Shortly After Acute Heart Failure Diagnosis
          • Time to Treatment Initiation After Diagnosis of Acute Heart Failure
          • Acute Heart Failure Requires Treatment Intervention
          • Percentage of Patients with De Novo Acute Heart Failure and Acute Decompensated Heart Failure Receiving Injectable Drugs During Inpatient Stay
          • Pharmacotherapy Choice in Acute Heart Failure Is Dictated by Patient Characteristics
          • Drug Classes Used to Treat Patients with Acute Decompensated Heart Failure
          • Drug Classes Used to Treat Patients with De Novo Acute Heart Failure
          • Drug Classes Prescribed in Acute Heart Failure Depending on Patient's Characteristics
          • Drug Classes Prescribed in Acute Heart Failure Depending on Patient's Blood Pressure
          • IV Loop Diuretic Drug Class Share Among Acute Heart Failure Patients
          • IV Nitrate Vasodilator Drug Class Share Among Acute Heart Failure Patients
          • Inotropic Sympathomimetic Drug Class Share Among Acute Heart Failure Patients
          • PDE3 Inhibitor Drug Class Share Among Acute Heart Failure Patients
          • Length of Treatment Does Not Significantly Differ Between the Main Acute Heart Failure Agents
          • Average Length of Treatment with IV Loop Diuretics
          • Average Length of Treatment with IV Nitrate Vasodilators
          • Average Length of Treatment with Inotropic Sympathomimetics
          • Average Length of Treatment with PDE3 Inhibitors
          • Some Acute Heart Failure Patients Require Nonpharmacological Intervention
          • Use of Nonpharmacological Approaches in Acute Heart Failure
          • Progression Between Lines of Therapy Depends on Patient Symptoms
          • Majority of Acute Heart Failure Patients Require Only One Line of Treatment
          • Percentage of Drug-Treated Patients Typically Progressing from One Line of Therapy to the Next
          • Progression Between Lines of Therapy is Driven by Insufficient Improvement of Symptoms
          • First-Line Treatment in Acute Heart Failure Is Dominated by Loop Diuretics
          • Product Patient Share by Line of Therapy
          • Combination Therapy Is Common in More Severe Acute Heart Failure
        • Persistency and Compliance
          • Persistency and Compliance Are High in Acute Heart Failure
          • Percentage of Patients Experiencing Early Discontinuation of Treatment with Acute Heart Failure Therapies
        • Sequencing of Treatment
          • Insufficient Efficacy Is the Main Reason for Treatment Change in Acute Heart Failure
          • Reasons for Switching to or Adding a New Drug for the Treatment of Acute Heart Failure
          • Rate of Dose Change, Addition of, or Switching to a New Drug Among Patients Whose Symptoms Are Not Controlled with an IV Loop Diuretic
          • Rate of Dose Change, Addition of, or Switching to a New Drug Among Patients Whose Symptoms Are Not Controlled with an IV Nitrate Vasodilator
          • Rate of Dose Change, Addition of, or Switching to a New Drug Among Patients Whose Symptoms Are Not Controlled with an Inotropic Agent
        • Recent/Anticipated Changes in Brand Use/Treatment Approach
          • Acute Heart Failure Drug Class Use Remains Stable
          • Changes in Overall Use of Treatment Approaches Over the Past Year in Patients with Acute Heart Failure
          • Expected Changes in Overall Use of Treatment Approaches in the Next Year for Patients with Acute Heart Failure
      • Physician Insight on Medical Practice
        • Key Findings
        • Drivers of Treatment Selection
          • Clinical Factors Are Key Drivers Influencing Prescribers
          • Treatment Choice Is Influenced by a Drug's Efficacy
          • Importance of Drug Attributes in Choice of Initial Therapy for Acute Heart Failure Patients
          • Efficacy in Relieving Symptoms and Stabilizing Patients Drive Prescribing
          • Various Obstacles Impact Prescribing of Acute Heart Failure Therapies
          • Acute Heart Failure Treatment Is Discontinued When No Longer Clinically Indicated
          • Rationale for Treatment Discontinuation by Therapy
      • Methodology
        • Primary Market Research Methodology
        • Years in Practice Post-Residency
        • Average Number of Acute Heart Failure Patients Treated per Month
        • Percentage of Patients Presenting with De Novo Acute Heart Failure versus Acute Decompensated Heart Failure
        • U.S. State of Practice Location
        • Drug Classes Prescribed to Acute Heart Failure Patients in the Past Year
        • Type of Practice Setting
        • Cardiologists’ Practice Type
        • Cardiologists’ Practice Location
      • Appendix
        • Primary Market Research
          • Methods Typically Used to Diagnose Acute Heart Failure
          • Number of Acute Heart Failure Episodes Experienced by Patients Within One Year
          • Percentage of Acute Decompensated Heart Failure Patients Treated with Oral Therapies Prior to Admission
          • Cardiologists' Views on the Existence of Acute Heart Failure Treatment Differences Between HFpEF and HFrEF
          • Percentage of Patients Prescribed Chronic Heart Failure Therapies at Discharge
          • Average Time Between Patient Discharge Following an Acute Heart Failure Episode and the First Follow-Up Visit
          • Type of Health Professional Who Sees the Patient During the Follow-Up Visit
          • Timing of the Initiation/Modification of Treatment with Oral Chronic Heart Failure Therapies Following an Acute Heart Failure Event
          • Cardiologists’ Most Important Reasons for Increased Use of Loop Diuretics in the Last Year
          • Cardiologists’ Most Important Reasons for Increased Use of Nitrate Vasodilators in the Last Year
          • Cardiologists’ Most Important Reasons for Increased Use of Inotropic Sympathomimetics in the Last Year
          • Cardiologists’ Most Important Reasons for Increased Use of PDE3 Inhibitors in the Last Year
          • Cardiologists’ Most Important Reasons for Increased Use of Natriuretic Peptide Receptor Agonists in the Last Year
          • Cardiologists’ Most Important Reasons for Decreased Use of Loop Diuretics in the Last Year
          • Cardiologists’ Most Important Reasons for Decreased Use of Nitrate Vasodilators in the Last Year
          • Cardiologists’ Most Important Reasons for Decreased Use of Inotropic Sympathomimetics in the Last Year
          • Cardiologists’ Most Important Reasons for Decreased Use of PDE3 Inhibitors in the Last Year
          • Cardiologists’ Most Important Reasons for Decreased Use of Natriuretic Peptide Receptor Agonists in the Last Year
          • Cardiologists’ Most Important Reason for Anticipated Increased Use of Loop Diuretics in the Next Year
          • Cardiologists’ Most Important Reason for Anticipated Increased Use of Nitrate Vasodilators in the Next Year
          • Cardiologists’ Most Important Reason for Anticipated Increased Use of Inotropic Sympathomimetics in the Next Year
          • Cardiologists’ Most Important Reason for Anticipated Increased Use of PDE3 Inhibitors in the Next Year
          • Cardiologists’ Most Important Reason for Anticipated Increased Use of Natriuretic Peptide Receptor Agonists in the Next Year
          • Cardiologists’ Most Important Reason for Anticipated Decreased Use of Loop Diuretics in the Next Year
          • Cardiologists’ Most Important Reason for Anticipated Decreased Use of Nitrate Vasodilators in the Next Year
          • Cardiologists’ Most Important Reason for Anticipated Decreased Use of Inotropic Sympathomimetics in the Next Year
          • Cardiologists’ Most Important Reason for Anticipated Decreased Use of PDE3 Inhibitors in the Next Year
          • Cardiologists’ Most Important Reason for Anticipated Decreased Use of Natriuretic Peptide Receptor Agonists in the Next Year
          • Cardiologists' Views on Current Treatment Approaches and Practices in Acute Heart Failure
        • Key Abbreviations
        • Bibliography

    Author(s): Dominika Rudnicka-Noulin, PhD, MSc

    Dominika Rudnicka-Noulin, PhD, MSc is a senior business insights analyst in the Cardiovascular, Metabolic and Renal division at Decision Resources Group, specializing in cardiovascular diseases, with expertise in heart failure and acute coronary syndrome.

    Prior to joining DRG, Dominika held a position of an associate editor at Nature Communications, working across a variety of therapy areas. Dominika also worked for three years as a Postdoctoral Research Associate on a joint project between Imperial College London and MedImmune aimed at developing more potent antibody-based drugs. Dominika gained her PhD at the Institut Pasteur in Paris, France where her work was funded by the European Commission Marie Skłodowska-Curie Actions


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