The new heart failure guidelines: strategies for implementation

Several life-prolonging therapies are available for the treatment of heart failure, yet they are underutilized in many patients. A treatment gap exists between patients who are eligible for a therapy and the number of patients who actually receive them. Suboptimal prescribing rates for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta-blockers, and aldosterone antagonists have been reported. Strategies are needed to increase the proportion of patients who are receiving evidence-based therapies. Predischarge initiation of evidence-based therapies has effectively increased utilization in the acute coronary syndrome population. Predischarge initiation of beta-blockade in patients hospitalized for heart failure has also been shown to be safe and effective for improving beta-blocker use at 60 days. Larger registry initiatives have demonstrated improved use of evidence-based therapies associated with implementation of a performance improvement process system. The mortality and morbidity associated with heart failure is strikingly high, and it is critical that proven therapies are prescribed to all eligible patients so that clinical outcomes can be improved. Systematic processes are effective approaches to ensuring appropriate evidence-based therapies are prescribed in most patients.