The role of in-hospital initiation of cardioprotective therapies to improve treatment rates and clinical outcomes.

Patients with heart failure face a very high risk of hospitalizations and mortality. Despite the compelling scientific evidence that beta-blockers reduce hospitalizations and mortality in patients with heart failure, this lifesaving therapy continues to be underutilized. A number of studies in a variety of clinical settings have documented that a significant proportion of patients with heart failure are not receiving treatment with this guideline-recommended, evidence-based therapy when guided by conventional care. A similar treatment gap has been documented for lipid-lowering therapy in patients with coronary heart disease. The demonstration that initiation of lipid-lowering and other cardioprotective medications prior to hospital discharge for atherosclerotic cardiovascular events results in a marked increase in treatment rates, improved long-term patient compliance, and better clinical outcomes has led to national guidelines being revised to endorse this approach as the standard of care. In-hospital initiation of beta-blocker therapy for heart failure could be reasonably expected to result in similar improvements in treatment rates and clinical outcomes. Recent data suggest that beta-blockers can be safely and effectively initiated in heart failure patients prior to hospital discharge, and that clinical outcomes are improved. Adopting in-hospital initiation of beta-blocker therapy as the standard of care for patients hospitalized with heart failure could dramatically improve treatment rates and thus substantially reduce the risk of future hospitalizations and prolong life in the large number of patients hospitalized each year.