Adherence to guideline-directed medical and device Therapy in outpAtients with heart failure with reduced ejection

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Umut Kocabaş1, Tarık Kıvrak2, Gülsüm Meral Yılmaz Öztekin3

  • 1Department of Cardiology, Başkent University Istanbul Hospital, Istanbul, Turkey.

Anatolian Journal of Cardiology
|July 7, 2020
PubMed

Insights

Guideline adherence for heart failure with reduced ejection fraction (HFrEF) is low. Many patients with HFrEF do not receive optimal medical therapy or recommended device treatments, despite guideline recommendations.

Area of Science:

  • Cardiology
  • Clinical Medicine
  • Pharmacology

Background:

  • Heart failure with reduced ejection fraction (HFrEF) management guidelines recommend specific pharmacologic and device therapies.
  • Despite these recommendations, significant inconsistencies in guideline adherence are observed in clinical practice.

Purpose of the Study:

  • To assess adherence to guideline-directed medical and device therapy in outpatients with chronic HFrEF (left ventricular ejection fraction ≤40%).
  • To identify gaps in the implementation of evidence-based treatments for HFrEF.

Main Methods:

  • Prospective, multicenter, observational study (Adherence to guideline-directed medical and device Therapy in outpAtients with HFrEF - ATA study).
  • Conducted across 24 centers from January 2019 to June 2019.
  • Included 1462 outpatients with chronic HFrEF.

Main Results:

  • While renin-angiotensin system (RAS) inhibitors (78.2%) and beta-blockers (90.2%) were commonly used, mineralocorticoid receptor antagonists (MRAs) (55.4%) and ivabradine (12.1%) were less frequent.
  • Low proportions of patients received target doses: RAS inhibitors (24.6%), beta-blockers (9.9%), and MRAs (10.5%).
  • Device therapy uptake was suboptimal: only 16.9% received an implantable cardioverter-defibrillator (ICD) and 34% underwent cardiac resynchronization therapy (CRT) among eligible patients.

Conclusions:

  • Most HFrEF outpatients receive basic RAS inhibitors and beta-blockers, but not MRAs or ivabradine, even when considering medical contraindications.
  • A significant gap exists in achieving target doses for medical therapies and in the utilization of guideline-recommended device therapies (ICD, CRT) for eligible HFrEF patients.
Abstract

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