(VP109) THE CANADIAN HEART FAILURE (CAN-HF) REGISTRY: A CANADIAN MULTI-CENTRE, RETROSPECTIVE STUDY OF OUTPATIENTS WITH HEART FAILURE

Background: Despite advances in medical therapies that reduce mortality and morbidity for patients with HF with reduced ejection fraction (HFrEF), registry studies conducted outside of Canada have documented suboptimal uptake of efficacious medical therapy. These registries have primarily described treatment of patients with HFrEF to the exclusion of those with HF with preserved EF (HFpEF). The present report was designed to describe real-world prescription of GDMT in Canadian outpatients with HFrEF or HFpEF.

METHODS AND RESULTS: CAN-HF was a retrospective, observational study of patients with HF, which included 1775 patients referred to 6 outpatient HF clinics in Quebec, Ontario, Manitoba and British Columbia between January 2017 and April 2020. Data from patients’ most recent visit to the clinic were captured and included patient demographics and medical history, HF etiology, medical therapy, laboratory values and EF. Most patients (55%) were referred by a cardiologist, and almost one-third of patients had been hospitalized for acute HF within the past 12 months. The mean (SD) age of patients was 71 (±14) years, and 66% were male. Most patients had a diagnosis of HFrEF (1319; 74%), followed by HFpEF (447; 25%); 9 patients ( < 1%) had unknown EF. Mean (SD) EF was 34 (±11)% and 58 (±8)% in patients with HFrEF and HFpEF, respectively. Common comorbidities for patients with HFrEF included hypertension (58%), coronary artery disease (CAD: 51%), atrial fibrillation (38%), diabetes (38%), and renal disease (30%). Patients with HFpEF had numerically lower incidence of CAD (31%), but higher rates of other comorbidities (hypertension: 66%, atrial fibrillation: 56%, diabetes: 45%, renal disease: 38%).

Treatment of patients with HFrEF included 72% of patients on diuretics, 80% on renin angiotensin aldosterone system inhibitors (RAASi; including 29% on angiotensin receptor-neprilysin inhibitor [ARNI]), 90% on beta blockers (βb), 55% on mineralocorticoid receptor antagonists (MRA), 3% on ivabradine, 6% on hydralazine, 14% on nitrates and 9% on digoxin. For patients with HFpEF, 87% were on diuretics, 47% on RAASi, 75% on βb, and 41% on MRA.

Conclusion: We observed higher prescription rates of GDMT for ambulatory patients with HFrEF in CAN-HF than in the US-based CHAMP-HF registry. Similarly, MRA use lagged behind that of RAASi and βb, with lower uptake of ARNI and ivabradine. Additionally, we describe real-world treatment of Canadian outpatients with HFpEF, a rapidly expanding patient population. Overall, a numerically higher proportion of patients with HFpEF were on diuretics, but a lower proportion were on RAASi and MRA than those with HFrEF.