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ALERT-HF: adherence to guidelines in the treatment of patients with chronic heart failure
Guarnaccia Franco1, Fimiani Biagio, Zito Giovanni Battista
1aA.R.C.A. (Associazioni Regionali Cardiologi Ambulatoriali), Campania, Via M. Testa, Salerno bLaboratorio di Elettrofisiologia, Clinica Mediterranea, Via Orazio, Naples cDepartment of Cardiology and Cardiac Surgery, University Hospital 'Scuola Medica Salernitana' Salerno dDepartment of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy eBoston Scientific Therapy Development, via Forlanini 23, Milan fDepartment of Translational Medical Sciences, University Federico II, Via Sergio Pansini, Naples, Italy *ALERT-HF Investigators: Alma Giovanni; Autiero Ciro; Carbone Vincenzo; Cardone Andrea; Carella Giovanni; Carotenuto Andrea; Ciotola Ciro; Di Giorgio Massimo; Ferrara Ferdinando; Fortunato Salvatore; Iandolo Alessandro; Lerro Luciana; Montefusco Domenico; Murolo Sabato; Olivares Maurizio; Soreca Silvia.
Insights
Adherence to chronic heart failure (CHF) treatment guidelines is poor, especially for aldosterone antagonists and anticoagulants in atrial fibrillation patients. Use of cardiac devices also lags significantly, impacting patient outcomes.
Area of Science:
- Cardiology
- Internal Medicine
- Pharmacology
Background:
- Current therapeutic guidelines can significantly improve the prognosis of chronic heart failure (CHF).
- Assessing adherence to these guidelines is crucial for optimizing patient care.
- Previous studies highlight variability in guideline adherence across different healthcare settings.
Purpose of the Study:
- To evaluate the adherence to current therapeutic guidelines in a cohort of chronic heart failure (CHF) patients.
- To identify specific areas of underuse for guideline-recommended therapies and interventions.
- To provide data for improving CHF management strategies.
Main Methods:
- A consecutive series of 660 CHF patients referred to ARCA cardiologists were evaluated.
- Adherence indicators included the use of ACE inhibitors/ARBs, beta-blockers, loop diuretics, aldosterone antagonists, digoxin, anticoagulants, and cardiac devices.
- Data were analyzed focusing on patients with reduced ejection fraction (≤45%).
Main Results:
- Among 528 patients with ejection fraction ≤45%, beta-blocker use was 75.6%, ACE inhibitor 53.4%, and ARB 37.7%.
- Loop diuretics were used by 88.9%, but aldosterone antagonists by only 30.9%.
- Anticoagulants were used in 64.2% of 148 patients with atrial fibrillation; cardiac device implantation was very low (31 patients).
Conclusions:
- There is poor adherence to current CHF therapeutic guidelines, particularly for aldosterone antagonists and anticoagulation in atrial fibrillation.
- Adherence to guidelines for implantable cardiac devices is notably deficient.
- The findings suggest a need for targeted interventions to improve guideline implementation in CHF care.
Background:
The prognosis of chronic heart failure (CHF) may be substantially improved by strict adherence to current therapeutic guidelines.
Aim And Methods:
To assess the adherence to current guidelines, 660 CHF patients consecutively referred to the ARCA (Associazioni Regionali Cardiologi Ambulatoriali Campania) cardiologists were evaluated. As indicators of adherence to the guidelines, we considered use of angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers, beta-blockers, loop diuretics, aldosterone antagonists, digoxin, anticoagulant therapy, and implantation of cardiac devices.
Results:
The adherence to guidelines has been characterized in patients with reduced ejection fraction, who represent the majority in the ALERT-HF (Adherence to Guidelines in the Treatment of patients with Chronic Heart Failure) trial and in whom the current guidelines are well defined and shared. Among 528 patients affected by CHF with ejection fraction 45% or less, 399 (75.6%) were treated with a beta-blocker, 282 (53.4%) received an angiotensin-converting enzyme inhibitor and 199 (37.7%) an angiotensin receptor blocker. Four hundred and sixty-nine patients (88.9%) used loop diuretics, but only 163 patients (30.9%) an aldosterone antagonist. Among 148 patients with atrial fibrillation, 95 (64.2%) were treated with anticoagulants. As few as 31 patients received cardiac electrical stimulation devices: 10 patients were implanted with a cardioverter-defibrillator and 21 received a device for cardiac resynchronization therapy.
Conclusion:
The study reveals poor adherence to current therapeutic guidelines for CHF, particularly with regard to aldosterone antagonists and anticoagulant therapy in the presence of atrial fibrillation. Even poorer is the adherence to guidelines as regards the use of implantable cardiac devices. The underlying reasons are discussed in relation to the data of other registries.
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