Gaps in Medical and Device Therapy for Patients with Left Ventricular Systolic Dysfunction: The EchoGap Study

Area of Science:

• Cardiology
• Pharmacology
• Medical Devices

Background:

• Left ventricular systolic dysfunction (LVSD) affects millions globally.
• Evidence-based guidelines recommend specific medications and defibrillator therapy for LVSD management.
• Gaps in guideline adherence can lead to suboptimal patient outcomes.

Purpose of the Study:

• To evaluate adherence to guidelines for medication prescription and defibrillator referral in LVSD patients.
• To identify discrepancies between recommended and actual clinical practice.

Main Methods:

• Screening of outpatient echocardiography reports for patients with LVEF < 40%.
• Physician questionnaires on ACE-inhibitor, ARB, and beta-blocker prescription and dosing.
• Assessment of implantable cardiac defibrillator (ICD) referral for patients with LVEF < 30%.

Main Results:

• High prescription rates for ACEi/ARB (84.1%) and beta-blockers (83.1%) were observed.
• Only 42.1% of patients on ACEi, 15.5% on ARB, and 3.5% on beta-blockers received target doses.
• 55.3% of eligible patients had an ICD or referral, with 42.1% having an ICD and 9.4% referred.

Conclusions:

• While medication prescription rates are high, achieving target doses for LVSD treatment remains a challenge.
• Defibrillator therapy uptake and referral rates are suboptimal in patients meeting criteria.
• Identifying reasons for non-adherence is crucial for improving evidence-based care in LVSD.