Stephen J Greene1, Javed Butler2, Nancy M Albert3, Adam D DeVore1, Puza P Sharma4, Carol I Duffy4, C Larry Hill5, Kevin McCague4, Xiaojuan Mi5, J Herbert Patterson6, John A Spertus7, Laine Thomas5, Fredonia B Williams8, Adrian F Hernandez1, Gregg C Fonarow9. 1. Duke Clinical Research Institute, Durham, North Carolina; Division of Cardiology, Duke University School of Medicine, Durham, North Carolina. 2. Department of Medicine, University of Mississippi, Jackson, Mississippi. 3. Cleveland Clinic Foundation, Cleveland, Ohio. 4. Novartis Pharmaceuticals Corporation, East Hanover, New Jersey. 5. Duke Clinical Research Institute, Durham, North Carolina. 6. Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina. 7. Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri. 8. Mended Hearts, Huntsville, Alabama. 9. Ahmanson-UCLA Cardiomyopathy Center, University of California-Los Angeles, Los Angeles, California. Electronic address: gfonarow@mednet.ucla.edu.
Abstract
BACKGROUND: Guidelines strongly recommend patients with heart failure with reduced ejection fraction (HFrEF) be treated with multiple medications proven to improve clinical outcomes, as tolerated. The degree to which gaps in medication use and dosing persist in contemporary outpatient practice is unclear. OBJECTIVES: This study sought to characterize patterns and factors associated with use and dose of HFrEF medications in current practice. METHODS: The CHAMP-HF (Change the Management of Patients with Heart Failure) registry included outpatients in the United States with chronic HFrEF receiving at least 1 oral medication for management of HF. Patients were characterized by baseline use and dose of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB), angiotensin receptor neprilysin inhibitor (ARNI), beta-blocker, and mineralocorticoid receptor antagonist (MRA). Patient-level factors associated with medication use were examined. RESULTS: Overall, 3,518 patients from 150 primary care and cardiology practices were included. Mean age was 66 ± 13 years, 29% were female, and mean EF was 29 ± 8%. Among eligible patients, 27%, 33%, and 67% were not prescribed ACEI/ARB/ARNI, beta-blocker, and MRA therapy, respectively. When medications were prescribed, few patients were receiving target doses of ACEI/ARB (17%), ARNI (14%), and beta-blocker (28%), whereas most patients were receiving target doses of MRA therapy (77%). Among patients eligible for all classes of medication, 1% were simultaneously receiving target doses of ACE/ARB/ARNI, beta-blocker, and MRA. In adjusted models, older age, lower blood pressure, more severe functional class, renal insufficiency, and recent HF hospitalization generally favored lower medication utilization or dose. Social and economic characteristics were not independently associated with medication use or dose. CONCLUSIONS: In this contemporary outpatient HFrEF registry, significant gaps in use and dose of guideline-directed medical therapy remain. Multiple clinical factors were associated with medication use and dose prescribed. Strategies to improve guideline-directed use of HFrEF medications remain urgently needed, and these findings may inform targeted approaches to optimize outpatient medical therapy.
BACKGROUND: Guidelines strongly recommend patients with heart failure with reduced ejection fraction (HFrEF) be treated with multiple medications proven to improve clinical outcomes, as tolerated. The degree to which gaps in medication use and dosing persist in contemporary outpatient practice is unclear. OBJECTIVES: This study sought to characterize patterns and factors associated with use and dose of HFrEF medications in current practice. METHODS: The CHAMP-HF (Change the Management of Patients with Heart Failure) registry included outpatients in the United States with chronic HFrEF receiving at least 1 oral medication for management of HF. Patients were characterized by baseline use and dose of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB), angiotensin receptor neprilysin inhibitor (ARNI), beta-blocker, and mineralocorticoid receptor antagonist (MRA). Patient-level factors associated with medication use were examined. RESULTS: Overall, 3,518 patients from 150 primary care and cardiology practices were included. Mean age was 66 ± 13 years, 29% were female, and mean EF was 29 ± 8%. Among eligible patients, 27%, 33%, and 67% were not prescribed ACEI/ARB/ARNI, beta-blocker, and MRA therapy, respectively. When medications were prescribed, few patients were receiving target doses of ACEI/ARB (17%), ARNI (14%), and beta-blocker (28%), whereas most patients were receiving target doses of MRA therapy (77%). Among patients eligible for all classes of medication, 1% were simultaneously receiving target doses of ACE/ARB/ARNI, beta-blocker, and MRA. In adjusted models, older age, lower blood pressure, more severe functional class, renal insufficiency, and recent HF hospitalization generally favored lower medication utilization or dose. Social and economic characteristics were not independently associated with medication use or dose. CONCLUSIONS: In this contemporary outpatient HFrEF registry, significant gaps in use and dose of guideline-directed medical therapy remain. Multiple clinical factors were associated with medication use and dose prescribed. Strategies to improve guideline-directed use of HFrEF medications remain urgently needed, and these findings may inform targeted approaches to optimize outpatient medical therapy.
Authors: Stephen J Greene; G Michael Felker; Anna Giczewska; Andreas P Kalogeropoulos; Andrew P Ambrosy; Hrishikesh Chakraborty; Adam D DeVore; Marat Fudim; Steven E McNulty; Robert J Mentz; Muthiah Vaduganathan; Adrian F Hernandez; Javed Butler Journal: Can J Cardiol Date: 2019-02-07 Impact factor: 5.223
Authors: Merrill Thomas; Yevgeniy Khariton; Gregg C Fonarow; Suzanne V Arnold; Larry Hill; Michael E Nassif; Puza P Sharma; Javed Butler; Laine Thomas; Carol I Duffy; Adam D DeVore; Adrian Hernandez; Nancy M Albert; J Herbert Patterson; Fredonia B Williams; Kevin McCague; John A Spertus Journal: JACC Heart Fail Date: 2019-06-05 Impact factor: 12.035
Authors: Poghni A Peri-Okonny; Xiaojuan Mi; Yevgeniy Khariton; Krishna K Patel; Laine Thomas; Gregg C Fonarow; Puza P Sharma; Carol I Duffy; Nancy M Albert; Javed Butler; Adrian F Hernandez; Kevin McCague; Fredonia B Williams; Adam D DeVore; J Herbert Patterson; John A Spertus Journal: JACC Heart Fail Date: 2019-02-06 Impact factor: 12.035