Administration of RAAS Inhibitors in Czech Patients with Heart Failure in Real Practice

Purpose and Aim of the Analysis

RAAS inhibitors prolong the survival of patients with heart failure with reduced ejection fraction. Sacubitril/valsartan from the ARNI group has been shown to reduce mortality and the risk of hospitalization for heart failure compared to enalapril. The aim of the authors of the cited analysis was to determine how these findings have been reflected in real clinical practice. They decided to evaluate the use of individual products from these drug classes in patients with heart failure throughout the Czech Republic in recent years and to compare it with current recommended procedures for the treatment of heart failure.

Results for 2018

According to a retrospective observational analysis, a total of 285,745 people lived in the Czech Republic with heart failure in 2018, of whom 76.7% used ACEi/ARBs in that year. When the authors focused on the data of those who underwent a medical procedure or examination in 2018 in connection with the diagnosis code I50.x according to the International Classification of Diseases (ICD-10), they found that 88.6% of these patients used ACEi/ARBs.

Among ACEi, the most frequently prescribed for patients with heart failure in 2018 were ramipril (17.5%) and perindopril (15.5%). The most frequently prescribed ARBs for patients with heart failure were telmisartan (6.5%) and losartan (4.9%). In just under a quarter of cases, ACEi/ARBs were prescribed in fixed combination with another drug. ARNI started to be prescribed from 2017, when 0.2% of patients with heart failure used them, and this number increased to 1% in 2018.

Summary and Conclusion

National data correspond to findings from individual regional registers focused on heart failure. They also demonstrate a good transfer of current recommendations for the treatment of heart failure into Czech clinical practice. The most used ACEi for patients with heart failure from 2012 to 2018 remained ramipril and perindopril, and the most prescribed sartan for these patients became telmisartan, followed by losartan (contrary to 2012, when the order of these 2 ARBs was reversed). Since 2017, ARNI has begun to play a role in the treatment of heart failure, and their prescription rate continues to rise.

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Source: Aiglová R., Táborský M., Lazarová M. et al. 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. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2022 Sep; 166 (3): 322−327, doi: 10.5507/bp.2021.035.