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How are patients with heart failure treated in primary care?


Hélène Vaillant-Roussel, Bruno Pereira, Sylvaine Gibot-Boeuf

    International Journal of Clinical Pharmacology and Therapeutics
    |May 25, 2018
    PubMed

    Insights

    General practitioners (GPs) showed suboptimal adherence to heart failure guidelines. Few patients with heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) achieved target drug doses, indicating a need for better treatment optimization tools.

    Area of Science:

    • Cardiology
    • General Practice
    • Pharmacotherapy

    Background:

    • Heart failure management guidelines exist for both reduced (HFrEF) and preserved (HFpEF) ejection fractions.
    • General practitioners (GPs) play a crucial role in implementing these guidelines.
    • Optimizing pharmacotherapy in heart failure is essential for patient outcomes.

    Purpose of the Study:

    • To evaluate GP adherence to heart failure guidelines for HFrEF patients.
    • To describe GP prescribing patterns for HFpEF patients.
    • To identify gaps in guideline adherence and treatment optimization.

    Main Methods:

    • A cross-sectional study was conducted as part of the ETIC trial.
    • Prescribing data for five key drug classes were analyzed: ACEIs/ARBs, BBs, MRAs, diuretics, and digoxin.
    • Patient adherence to guideline recommendations and achievement of target doses were assessed.

    Main Results:

    • In HFrEF patients, only 6% achieved all target drug doses (GAI-3).
    • In HFpEF patients, high rates of ACEIs/ARBs (81.3%) and diuretics (75.8%) were observed, but MRA use was low (13.3%).
    • A significant proportion of patients received drugs not authorized for their specific heart failure indication, and target doses were infrequently achieved.

    Conclusions:

    • Current GP prescribing for heart failure indicates suboptimal guideline adherence and treatment optimization.
    • Many patients are treated with non-recommended drugs or fail to reach target therapeutic doses.
    • Development of practical tools is needed to support GPs and cardiologists in optimizing heart failure pharmacotherapy.
    Abstract

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