Author + information
- Received October 24, 2018
- Revision received November 20, 2018
- Accepted November 20, 2018
- Published online March 25, 2019.
- Poghni A. Peri-Okonny, MDa,∗ (, )
- Xiaojuan Mi, PhDb,
- Yevgeniy Khariton, MD, MSca,
- Krishna K. Patel, MD, MSca,
- Laine Thomas, PhDb,
- Gregg C. Fonarow, MDc,
- Puza P. Sharma, MBBS, MPH, PhDd,
- Carol I. Duffy, DOd,
- Nancy M. Albert, PhDe,
- Javed Butler, MD, MPHf,
- Adrian F. Hernandez, MDb,
- Kevin McCague, MAd,
- Fredonia B. Williams, EdDg,
- Adam D. DeVore, MDb,
- J. Herbert Patterson, PharmDh and
- John A. Spertus, MD, MPHa,i
- aUniversity of Missouri, Kansas City, Missouri
- bDuke Clinical Research Institute, Durham, North Carolina
- cUniversity of California Los Angeles, Los Angeles, California
- dNovartis Pharmaceuticals Corporation, East Hanover, New Jersey
- eCleveland Clinic, Cleveland, Ohio
- fUniversity of Mississippi, University, Mississippi
- gMended Hearts, Hunstville, Alabama
- hUniversity of North Carolina, Chapel Hill, North Carolina
- iSaint Luke’s Mid America Heart Institute, Kansas City, Missouri
- ↵∗Address for correspondence:
Dr. Peri-Okonny, Saint Luke’s Mid America Heart Institute, 4401 Wornall Road, Kansas City, Missouri 64111.
Objectives This study sought to determine the rate of use of target doses of foundational guideline-directed medical therapy (GDMT) in a contemporary cohort of patients with heart failure with reduced ejection fraction (HFrEF) across systolic blood pressure (SBP) categories.
Background Patients with HFrEF are infrequently titrated to recommended doses of GDMT. The relationship between SBP and achieving GDMT target doses is not well studied.
Methods Patients enrolled in the CHAMP-HF (Change the Management of Patients With Heart Failure) registry without documented intolerance to angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitors (ARNIs), and beta blockers (BBs) were assessed at enrollment. We estimated the proportion receiving target doses (% of target dose [95% confidence interval (CI)]) based on the most recent American College of Cardiology/American Heart Association/Heart Failure Society of America heart failure guidelines at baseline in all patients, and by SBP category (≥110 vs. <110 mm Hg).
Results Of the 3,095 patients eligible for analysis, 2,421 (78.2%) had SBP ≥110 mm Hg. The proportion of patients receiving target doses were 18.7% (95% CI: 17.3% to 20.0%; BB), 10.8% (95% CI: 9.7% to 11.9%; ACEI/ARB), and 2.0% (95% CI: 1.5% to 2.5%; ARNI). Among those with SBP <110 mm Hg (n = 674), 17.5% (95% CI: 14.6% to 20.4%; BB), 6.2% (95% CI: 4.4% to 8.1%; ACEI/ARB), and 1.8% (95% CI: 0.8% to 2.8%; ARNI) were receiving target doses. Among those with SBP ≥110 mm Hg (n = 2,421), 19.0% (95% CI: 17.4% to 20.6%; BB), 12.1% (95% CI: 10.8% to 13.4%; ACEI/ARB), and 2.0% (95% CI: 1.5% to 2.6%; ARNI) were receiving target doses.
Conclusions In a large, contemporary registry of outpatients with chronic HFrEF eligible for treatment with BBs and ACEI/ARB/ARNI, <20% of patients were receiving target doses, even among those with SBP ≥110 mm Hg.
CHAMP-HF is funded by the Novartis Pharmaceuticals Corporation. Drs. Peri-Okonny, Khariton, and Patel are supported by the National Heart, Lung, and Blood Institutes of Health under award number T32HL110837. Dr. Thomas has received grants from Novartis Pharmaceuticals Corporation. Dr. Fonarow has received grants from the National Institutes of Health; has received personal fees from Abbott, Amgen, Janssen, Medtronic, and Novartis Pharmaceuticals Corporation; and has been on the steering committee for Get With the Guidelines. Drs. Sharma, Duffy, and McCague are employed by and have stock ownership with Novartis Pharmaceuticals Corporation. Dr. Albert has received personal fees from Novartis Pharmaceuticals Corporation. Dr. Butler has received grants from the National Institutes of Health and the European Union; and has received personal fees from Abbott, Adrenomed, Amgen, Array, AstraZeneca, Bayer, BerlinCures, Boehringer Ingelheim, Bristol-Myers Squibb, Cardiocell, CVRx, G3 Pharmaceuticals, Immolife, Janssen, Lantheus, LinaNova, Luitpold, Medscape, Medtronic, Merck, Novartis Pharmaceuticals Corporation, NovoNordisk, Relypsa, Roche, Sanofi, StealthPeptide, SC Pharma, V-Wave Limited, Vifor, and ZS Pharma. Dr. Hernandez has received grants from AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, Luitpold Pharmaceuticals, Merck, and Novartis Pharmaceuticals Corporation; and has received personal fees from Bayer, Boston Scientific, and Novartis Pharmaceuticals Corporation. Dr. DeVore has received research funding from Akros Medical, American Heart Association, NIH, Amgen, Bayer, Intra-Cellular Therapies, Luitpold Pharmaceuticals, NHLBI, Novartis Pharmaceuticals Corporation, and Patient-Centered Outcomes Research Instititute (PCORI); and has received personal fees from Novartis Pharmaceuticals Corporation. Dr. Patterson has received grants from Amgen, Bristol-Myers Squibb, Merck, and Novartis Pharmaceuticals Corporation; and has received personal fees from Novartis Pharmaceuticals Corporation, Amgen, Otsuka, Merck, Boehringer Ingelheim, and Bristol-Myers Squibb. Dr. Spertus has received grants from the National Institutes of Health, Bayer, and Abbott Vascular; has received support from Novartis Pharmaceuticals Corporation; has received personal fees from Bayer, AstraZeneca, United Healthcare, MyoCardia, and Janssen; has intellectual property rights for the Kansas City Cardiomyopathy Questionnaire; and has an equity interest in Health Outcomes Sciences. The content herein is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 24, 2018.
- Revision received November 20, 2018.
- Accepted November 20, 2018.
- 2019 American College of Cardiology Foundation
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