TY - JOUR
T1 - Is heart failure guideline adherence being underestimated? the impact of therapeutic contraindications
AU - Atwater, Brett D.
AU - Dai, David
AU - Allen-Lapointe, Nancy M.
AU - Al-Khatib, Sana M.
AU - Zimmer, Louise O.
AU - Sanders, Gillian D.
AU - Peterson, Eric D.
N1 - Funding Information:
Brett Atwater receives research funding from AHA. David Dai has no disclosures. Nancy Allen LaPointe received research funding from Pfizer. Sana Al-Khatib receives research support from Bristol-Meyers Squibb. Louise Zimmer has no disclosures. Gillian Sanders receives consulting fees from Glaxo Smith-Kline. Eric Peterson receives research funding from Eli Lilly and Johnson and Johnson.
Funding Information:
The study was approved by the Durham Veterans Administration Institutional Review Board and was supported in part by grant U18HS016964 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare Research and Quality. The authors are solely responsible for the design and conduct of this study, all study analyses, and drafting and editing of the manuscript.
PY - 2012/11
Y1 - 2012/11
N2 - Background: Several studies based on claims data have reported underutilization of evidence-based heart failure (HF) therapies. The degree to which these estimates fail to account for therapeutic contraindications is unclear. Methods: We identified patients with HF and left ventricular ejection fraction ≤45% seen between January 1, 2010, and July 1, 2010, at a tertiary care Veterans Affairs Medical Center. Medical records were abstracted to evaluate utilization of and contraindications to β-blocker, angiotensin-converting enzyme inhibitor, aldosterone antagonist, anticoagulation for atrial fibrillation, implantable cardioverter-defibrillator, and cardiac resynchronization therapies. Results: Of the 178 patients with HF and an ejection fraction ≤45%, 78 (44%) received every guideline-recommended therapy. After accounting for medical contraindications, 77 (72%) of 107 patients received every guideline-recommended therapy. Adherence to recommendations for β-blocker (98%), angiotensin-converting enzyme inhibitor/angiotensin blocker (95%), and anticoagulation (97%) were better than adherence to implantable cardioverter-defibrillator (82%), cardiac resynchronization therapy (59%), or aldosterone antagonist (51%) recommendations. In adjusted analysis, lower New York Heart Association functional class and care by a cardiologist were associated with improved guideline adherence (P <.001). Conclusions: Many patients with HF have therapeutic contraindications, and a failure to account for these may lead to a large underestimation of the true guideline adherence rates.
AB - Background: Several studies based on claims data have reported underutilization of evidence-based heart failure (HF) therapies. The degree to which these estimates fail to account for therapeutic contraindications is unclear. Methods: We identified patients with HF and left ventricular ejection fraction ≤45% seen between January 1, 2010, and July 1, 2010, at a tertiary care Veterans Affairs Medical Center. Medical records were abstracted to evaluate utilization of and contraindications to β-blocker, angiotensin-converting enzyme inhibitor, aldosterone antagonist, anticoagulation for atrial fibrillation, implantable cardioverter-defibrillator, and cardiac resynchronization therapies. Results: Of the 178 patients with HF and an ejection fraction ≤45%, 78 (44%) received every guideline-recommended therapy. After accounting for medical contraindications, 77 (72%) of 107 patients received every guideline-recommended therapy. Adherence to recommendations for β-blocker (98%), angiotensin-converting enzyme inhibitor/angiotensin blocker (95%), and anticoagulation (97%) were better than adherence to implantable cardioverter-defibrillator (82%), cardiac resynchronization therapy (59%), or aldosterone antagonist (51%) recommendations. In adjusted analysis, lower New York Heart Association functional class and care by a cardiologist were associated with improved guideline adherence (P <.001). Conclusions: Many patients with HF have therapeutic contraindications, and a failure to account for these may lead to a large underestimation of the true guideline adherence rates.
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U2 - 10.1016/j.ahj.2012.08.002
DO - 10.1016/j.ahj.2012.08.002
M3 - Article
C2 - 23137506
AN - SCOPUS:84868608362
SN - 0002-8703
VL - 164
SP - 750-e1
JO - American heart journal
JF - American heart journal
IS - 5
ER -