Evaluating the impact of the national heart failure implementation program on survival and care optimization in Western Sweden

Abstract Background Optimizing heart failure (HF) management is a key healthcare priority. Sweden's National Heart Failure Implementation Program (PSV-HF) aimed to standardize and improve HF care by focusing on guideline-directed therapy and structured care pathways. Aim To analyze guideline-directed medical therapy (GDMT) prescriptions and survival among HF patients enrolled in PSV-HF versus those outside the program in Western Sweden (January 1, 2021 – June 30, 2024). Methods This study compared patients enrolled in the PSV-HF with patients outside the program during the same time period, i.e. control patients, from primary care and specialist care. Data were sourced from regional registers, the healthcare database Vega, the population register Västfolket, and the Prescribed Drug Register Digitalis. Survival analysis used Kaplan-Meier curves and Cox proportional hazards models adjusted for clinical covariates. Results A total of 24,186 newly diagnosed HF patients were included, 10,682 PSV-HF patients, 9,785 primary care controls, and 5,070 specialist care controls. Compared to primary care controls, PSV-HF patients were younger (75 vs 82 years), more often male (58.2% vs 41.2%), and had more cardiovascular comorbidities. Smaller differences were observed between PSV-HF patients and specialist care controls. Within one year of diagnosis, GDMT prescriptions were higher in PSV-HF patients than primary care controls and specialist care controls respectively, regardless of ejection fraction: ACEI/ARB (81.6% vs 63.5% and 66.4%), ARNI (12.3% vs 0.4% and 1.3%), Beta-blockers (84.9% vs 69.8% and 72.2%), MRA (47.6% vs 17.4% and 22.1%), SGLT2 inhibitors (41.8% vs 10.4% and 14.9%), and Diuretics (76.1% vs 67.8% and 61%). Quadruple therapy use at 30, 90, and 180 days remained low (32.8%, 39.5%, 43.8%) among PSV-HF patients but was nearly three times higher than in specialist care controls (10.5%, 14.2%, 16.8%) and even greater compared to primary care controls (3.6%, 5.2%, 6.5%). After adjusting for age, sex, comorbidities, and medication use, PSV-HF patients had a significantly lower all-cause mortality risk than specialist care controls, HR 0.70 (95% CI 0.61–0.81) at 6 months, HR 0.74 (95% CI 0.65–0.83) at 12 months, HR 0.77 (95% CI 0.70–0.86) at 24 months. Kaplan-Meier curves confirmed better one-year survival in PSV-HF patients compared to non-enrolled patients in specialist care, Figure 1. Conclusions The PSV-HF program has significantly improved HF care pathways and patient outcomes. However, further optimization, especially in quadruple therapy implementation, remains a priority.