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

Hisham Dokainish1, Lauren Jewett1, Robby Nieuwlaat1

  • 1Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.

The Open Cardiovascular Medicine Journal
|October 25, 2014
PubMed

Insights

Prescription rates for heart failure medications are high in patients with LVSD, but target doses are often missed. Many eligible patients lack defibrillators or referral, indicating gaps in evidence-based care.

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.
Abstract

Keywords:
EchocardiographyEvidence-based MedicineHeart FailureKnowledge TranslationLeft Ventricular DysfunctionTreatment Gaps.

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