Author + information
- Received August 10, 2018
- Revision received October 10, 2018
- Accepted October 14, 2018
- Published online December 31, 2018.
- Hans-Peter Brunner-La Rocca, MDa,∗ (, )@MaastrichtU,
- Gerard C. Linssen, MD, PhDb,
- Frank J. Smeele, MD, PhDc,
- Annemarie A. van Drimmelen, RNd,
- Henk-Jan Schaafsma, MDe,
- Paul H. Westendorp, MDf,
- Philip C. Rademaker, MDg,
- Hendrik J. van de Kamp, MSch,
- Arno W. Hoes, MD, PhDi,j,
- Jasper J. Brugts, MD, PhD, MSck,
- for the CHECK-HF Investigators
- aDepartment of Cardiology, Maastricht University Medical Center, Maastricht, Limburg, the Netherlands
- bDepartment of Cardiology, Hospital Group Twente, Almelo and Hengelo, Hengelo, the Netherlands
- cDepartment of Cardiology, Slingeland Hospital, Doetinchem, the Netherlands
- dDepartment of Cardiology, Amphia Hospital, Breda, the Netherlands
- eDepartment of Cardiology, Hospital Gelderse Vallei, Ede, the Netherlands
- fDepartment of Cardiology, Rivas Beatrix Hospital, Gorinchem, the Netherlands
- gDepartment of Cardiology, ZorgSaam Hospital, Terneuzen, the Netherlands
- hBusiness Unit Cardiometabolic, Servier Pharma, Leiden, the Netherlands
- iJulius Center for Health Sciences and Primary Care, Utrecht, the Netherlands
- jDepartment of Epidemiology, University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands
- kDepartment of Cardiology, Erasmus University Medical Center, Thoraxcenter, Rotterdam, the Netherlands
- ↵∗Address for correspondence:
Dr. Hans-Peter Brunner-La Rocca, Department of Cardiology, Maastricht University Medical Center, PO Box 5800, 6202 AZ Maastricht, the Netherlands.
Objectives This study investigated adherence to drug therapy guidelines in heart failure (HF) with reduced left-ventricular ejection fraction (LVEF) of <40% (heart failure with reduced ejection fraction [HFrEF]), in which evidence-based treatment has been established.
Background Despite previous surveys of HF, important uncertainties remain regarding guideline adherence in a representative real-world population.
Methods A cross-sectional registry in 34 Dutch HF outpatient clinics that included 10,910 patients with the diagnosis of HF was examined. Of that number, 8,360 patients had LVEF <50% (72 ± 12 years of age; 64% male) and were divided into HFrEF (n = 5,701), HF with mid-range LVEF (HFmrEF) with LVEF 40% to 49% (n = 1,574), and those with semiquantitatively measured LVEF but <50% (n = 1,085).
Results In the HFrEF group, 81% of the patients were treated with loop diuretics, 84% with renin-angiotensin-system (RAS) inhibitors, 86% with β-blockers, 56% with mineralocorticoid-receptor antagonists (MRA), and 5% with If-channel inhibition. Differences in medication use were minor among the 3 groups but were significant among centers. Inability to tolerate the medications was recorded in 9.4% patients taking RAS inhibitors, 3.3% taking β-blockers, and 5.4% taking MRAs. Median loop diuretic dose was 40 mg of furosemide equivalent, RAS inhibitor dose 50% of target, β-blocker dose 25% of target, and MRA dose 12.5 mg of spironolactone equivalent. Elderly patients were treated predominantly with diuretics and less often with RAS inhibitors, β-blockers, and MRAs.
Conclusions This large contemporary HF registry showed a relatively high use of evidence-based treatment, particularly in younger patients. However, the average dose of evidence-based medication was still lower than recommended by guidelines. Furthermore, the more recently introduced If-channel inhibition has hardly been adopted. There is ample room for improvement of HFrEF therapy, even more than 25 years after convincing evidence that HFrEF treatment leads to better outcome.
Data inclusion and software were supported by Servier. There was no funding source for analysis, data interpretation, and writing of the manuscript. Dr. Brunner-La Rocca has received research grants from Roche Diagnostics, Novartis, and Vifor. Dr. van de Kamp is an employee of Servier. All other authors have reported that they had no relationships relevant to the contents of this paper to disclose.
- Received August 10, 2018.
- Revision received October 10, 2018.
- Accepted October 14, 2018.
- 2019 American College of Cardiology Foundation
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