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Improved medical therapy may lead to better outcomes in treating HFrEF
An increased emphasis in improvement of medical therapy in patients with HF with reduced ejection fraction may lead to better outcomes, according to JACC: Heart Failure.
Researchers sought to investigate adherence to drug therapy guidelines in HF with left ventricular ejection fraction of less than 40%, in which evidence-based treatment was established.
Challenges of new treatment
“Adherence to guideline-recommended therapy in HF remains challenging,” Hans-Peter Brunner-La Rocca, MD, of department of cardiology at Maastricht University Medical Center, the Netherlands, and colleagues wrote. “Adoption of new treatment option requires many years, often decades.”
The cross-sectional CHECK-HF registry comprised 10,910 patients diagnosed with HF from 34 Dutch HF outpatient clinics. Researchers identified 8,360 patients with LVEF less than 50% (average age, 72 years; 64% men) and separated into groups with HFrEF (n = 5,701), HF with mid-range EF (n = 1,574) and semiquantitatively measured LVEF less than 50% (n = 1,085).
Researchers identified that in the HFrEF group, 81% of the patients were treated with loop diuretics, 84% with renin-angiotensin-system (RAS) inhibitors, 86% with beta-blockers, 56% with mineralocorticoid-receptor antagonists (MRA) and If-channel inhibition.
Brunner-La Rocca and colleagues identified the inability to tolerate medications occurred in 9.4% of patients taking RAS inhibitors, 3.3% of patients taking beta-blockers and 5.4% of patients taking MRAs. In all three groups, the median-loop diuretic dose was 40 mg furosemide equivalent or less, RAS inhibitor dose was 50% of target, beta-blocker dose was 25% of target and MRA dose was 12.5 mg spironolactone equivalent, researchers wrote.
Prescription rates of medication were influenced by patient age, researchers wrote.
“Importantly, there was a large variation among centers, which could not be explained by differences in patients’ characteristics. Medication in [HF with mid-range EF] patients did not differ much from that in HFrEF patients, and LVEF was not precisely measured in substantial number of patients,” Brunner-La Rocca and colleagues wrote. “Therefore, there is still significant room for (further) improvement of treatment of patients with reduced LVEF, even 30 years after the first study showing that prognosis can be improved in HFrEF.”
Knowing is not enough
In a related editorial, Stephen J. Greene, MD, and G. Michael Felker, MD, MHS, both from Duke Clinical Research Institute and the division of cardiology at the Duke University School of Medicine, wrote: “Attempts to use biomarkers such as natriuretic peptides to improve use of [guideline-directed medical therapy] have been mixed, but may point to better ways to optimize care. ... In the context of 50% 5-year mortality, substantial physical disability and caregiver burden, and enormous health care expenditure, every effort must be made to use all available tools proven to improve outcomes for patients with HFrEF. Knowing is not enough — we must do.” – by Earl Holland Jr.
Disclosures: Brunner-La Rocca reports he received research grants from Novartis, Roche Diagnostics and Vifor. Please see the study for all other authors’ relevant financial disclosures. Greene reports he was supported in part by an award funded by Novartis and received research support from Amgen and Novartis. Felker reports he received grants from Amgen and Merck and is a consultant for numerous pharmaceutical and device companies.