Medical Therapy for Heart Failure With Reduced Ejection Fraction

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:72

Article

Greene, Stephen J.^1,2  Butler, Javed³  Albert, Nancy M.⁴  DeVore, Adam D.^1,2  Sharma, Puza P.⁵  Duffy, Carol I.⁵  Hill, C. Larry¹  McCague, Kevin⁵  Mi, Xiaojuan¹  Patterson, J. Herbert⁶  Spertus, John A.^7,8  Thomas, Laine¹  Williams, Fredonia B.⁹  Hernandez, Adrian F.^1,2  Fonarow, Gregg C.¹⁰ 

[1] Duke Clin Res Inst, Durham, NC USA

[2] Duke Univ, Sch Med, Div Cardiol, Durham, NC USA

[3] Univ Mississippi, Dept Med, Jackson, MS 39216 USA

[4] Cleveland Clin Fdn, 9500 Euclid Ave, Cleveland, OH 44195 USA

[5] Novartis Pharmaceut, E Hanover, NJ USA

[6] Univ N Carolina, Eshelman Sch Pharm, Chapel Hill, NC 27515 USA

[7] St Lukes Mid Amer Heart Inst, Kansas City, MO USA

[8] Univ Missouri, Kansas City, MO 64110 USA

[9] Mended Hearts, Huntsville, AL USA

[10] Univ Calif Los Angeles, Ahmanson UCLA Cardiomyopathy Ctr, 10833 LeConte Ave,Room 47-123 CHS, Los Angeles, CA 90095 USA

关键词: dose;    medication;    reduced ejection fraction;    registry;   

DOI  :  10.1016/j.jacc.2018.04.070

来源: Elsevier

【 摘 要 】

BACKGROUND Guidelines strongly recommend patients with heart failure with reduced ejection fraction (HFrEF) be treated with multiple medications proven to improve clinical outcomes, as tolerated. The degree to which gaps in medication use and dosing persist in contemporary outpatient practice is unclear. OBJECTIVES This study sought to characterize patterns and factors associated with use and dose of HFrEF medications in current practice. METHODS The CHAMP-HF (Change the Management of Patients with Heart Failure) registry included outpatients in the United States with chronic HFrEF receiving at least 1 oral medication for management of HF. Patients were characterized by baseline use and dose of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB), angiotensin receptor neprilysin inhibitor (ARNI), beta-blocker, and mineralocorticoid receptor antagonist (MRA). Patientlevel factors associated with medication use were examined. RESULTS Overall, 3,518 patients from 150 primary care and cardiology practices were included. Mean age was 66 +/- 13 years, 29% were female, and mean EF was 29 +/- 8%. Among eligible patients, 27%, 33%, and 67% were not prescribed ACEI/ARB/ARNI, beta-blocker, and MRA therapy, respectively. When medications were prescribed, few patients were receiving target doses of ACEI/ARB (17%), ARNI (14%), and beta-blocker (28%), whereas most patients were receiving target doses of MRA therapy (77%). Among patients eligible for all classes of medication, 1% were simultaneously receiving target doses of ACE/ARB/ARNI, beta-blocker, and MRA. In adjusted models, older age, lower blood pressure, more severe functional class, renal insufficiency, and recent HF hospitalization generally favored lower medication utilization or dose. Social and economic characteristics were not independently associated with medication use or dose. CONCLUSIONS In this contemporary outpatient HFrEF registry, significant gaps in use and dose of guideline-directed medical therapy remain. Multiple clinical factors were associated with medication use and dose prescribed. Strategies to improve guideline-directed use of HFrEF medications remain urgently needed, and these findings may inform targeted approaches to optimize outpatient medical therapy. (C) 2018 by the American College of Cardiology Foundation.

【 授权许可】

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