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Use of Guideline-Directed Medications for Heart Failure Before Cardioverter-Defibrillator Implantation

Gregory A Roth1, Jeanne E Poole2, Rebecca Zaha3

  • 1Division of Cardiology and Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington.

Journal of the American College of Cardiology
|March 5, 2016
PubMed

Insights

Guideline-directed medical therapy (GDMT) use before implantable cardioverter-defibrillator (ICD) placement for heart failure with reduced ejection fraction (HFrEF) was low. Patients receiving GDMT had better 1-year survival rates after ICD implantation.

Area of Science:

  • Cardiology
  • Medical Therapy
  • Public Health

Background:

  • Guideline-directed medical therapy (GDMT) is recommended before primary prevention implantable cardioverter-defibrillator (ICD) placement for heart failure with reduced ejection fraction (HFrEF).
  • Adherence to GDMT recommendations and its impact on outcomes are not well-established.
  • This study investigates GDMT use and its association with mortality in HFrEF patients undergoing primary prevention ICD implantation.

Purpose of the Study:

  • To examine the utilization of GDMT (defined as filling prescriptions for both a renin-angiotensin inhibitor and a heart failure-approved beta-blocker) within 90 days before primary prevention ICD placement in HFrEF patients.
  • To identify factors associated with GDMT use.
  • To determine the association between GDMT use and 1-year mortality.

Main Methods:

  • Utilized data from the National Cardiovascular Data Registry ICD Registry merged with Medicare administrative data (2007-2011).
  • Analyzed prescription fills for GDMT in patients receiving primary prevention ICDs.
  • Examined GDMT use overall, by U.S. hospital referral region, and its association with 1-year mortality, adjusting for comorbidities.

Main Results:

  • Only 61.1% of 19,733 HFrEF patients received any GDMT before primary prevention ICD implantation.
  • GDMT use varied significantly across hospital referral regions (51% to 71%).
  • Patients receiving GDMT had lower 1-year mortality (11.1%) compared to those without (16.2%) after adjustment for key clinical factors.

Conclusions:

  • Rates of guideline-directed medical therapy for HFrEF prior to primary prevention ICD implantation are suboptimal.
  • Failure to achieve GDMT before ICD placement is linked to significantly reduced 1-year survival.
  • Improving GDMT adherence may enhance outcomes for HFrEF patients receiving primary prevention ICDs.
Abstract

Keywords:
defibrillatorhealth services researchheart failure

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