Optimizing the treatment of heart failure

Analysis of ambulatory heart failure management and its incidence on one-year survival

AIM

To assess in a daily practice survey one-year survival in a cohort of patients with heart failure (HF) according to their clinical profiles and the way they were managed by cardiologists.

METHODS AND RESULTS

A prospective observational survey was conducted in 1941 patients with HF followed up for one year. Results show high rates of prescription for ACE inhibitors, indicating that cardiologists take into account international recommendations. ACE inhibitors are prescribed at dosage levels approaching those recommended by the guidelines. However, beta-blocker prescription still shows a significant deficit and the prescribed doses are much lower than those currently recommended. The multifactorial modeling analysis showed that global heart failure (P=0.004), advanced NYHA class (P<0.001), renal failure (P<0.001) were predictive of poor outcome whereas an increased survival likelihood was observed in patients given ACE-inhibitor/beta-blocker combination compared with beta-blocker alone or ACE-inhibitor alone.

CONCLUSION

The results from this study should enhance the prescription of ACE inhibitors and beta-blockers at effective doses in compliance with the guidelines. They also suggest that a synergic positive effect of the combination of these two therapeutic classes is observed in real life situations.

Ambulatory heart failure management in private practice in France

Management of ambulatory heart failure was assessed in a group of 600 patients, mean age 73, 64% males, NYHA I: 9%; II: 52%; III: 33%; IV: 6%; followed up by a representative sample of private cardiologists. Fifty-two percent of patients had been previously hospitalised for worsening heart failure with a mean duration of stay of 13.1 days, for those hospitalised in the year preceding the survey (26%). First diagnosis of heart failure had been performed by a cardiologist (57%), a general practitioner (37%) or another category of physician (6%). Seventy percent of patients received three or more different classes of heart failure medications. Diuretics were prescribed to 71%, angiotensin converting enzyme inhibitors to 54% and digitalis to 35% of the population. Beta-blockers were given to only 14% of the patients. In patients aged over 80 years, only 45% received angiotensin converting enzyme inhibitors.

CONCLUSION

This survey of ambulatory heart failure patients confirms that the disease is predominantly observed in elderly patients, and associated with prolonged and recurrent hospitalisations. The underuse of recommended therapeutic classes including angiotensin converting enzyme inhibitors and beta-blockers deserves further investigation.