Actual state of “triple therapy” for heart failure patients in eight regions of Japan: An analysis of a nationwide medical claims database

BACKGROUND: This study aimed to collect data on “triple therapy” for heart failure (HF) with angiotensin-converting enzyme inhibitors (or receptor blockers), β-blockers, and mineralocorticoid receptor antagonists in all eight regions of Japan and clarify the reason for the selection of this therapeutic approach. METHODS AND RESULTS: We used data from April 2017 to March 2018 from the Medical Data Vision database (380 facilities) to analyze factors impacting triple therapy for HF. Among patients who were hospitalized for HF during the study period, 51,933 patients met the inclusion criteria and underwent further analyses. A reference value of 20.45% from Kanto was used to compare the eight Japanese regions. From the patient cohort, 10,006 (19.27%) patients receiving triple therapy were identified. The highest and lowest rates of triple therapy were in Chugoku (21.90%) and Shikoku (14.27%), respectively, suggesting regional differences in the use of triple therapy at discharge for patients with HF (P < 0.001). Regression analysis revealed a decrease in the administration of triple therapy for patients with chronic kidney disease (odds ratio [OR], 0.45; 95% confidence interval [CI], 0.43–0.48]; P < 0.001), those aged 75 years and older (OR, 0.46, 95% CI: 0.44–0.49; P < 0.001), those from Shikoku (OR, 0.69; 95% CI, 0.60–0.80; P < 0.001), those with chronic obstructive pulmonary disease (OR, 0.75; 95% CI, 0.68–0.84; P < 0.001), those with anemia (OR, 0.78; 95% CI, 0.62–0.98; P = 0.034), and those from Tohoku (OR, 0.83; 95% CI, 0.75–0.92; P < 0.001). CONCLUSIONS: Future efforts to rectify the regional variance in drug therapy conforming to the guidelines for the treatment of acute and chronic HF will help to extend the healthy lifespans of patients with HF. Further clarification is required to determine instances where triple therapy should be avoided based on patient factors, and appropriate countermeasures should be identified.