Improved HF therapy use could prevent ‘substantial number’ of deaths
MedWire News: Tens of thousands of deaths from heart failure (HF) in the USA could be prevented by optimal implementation of six evidence-based therapies, research suggests.
Although these therapies have been shown to reduce mortality in HF patients with low left ventricular ejection fraction (LVEF), clinical application has been slow and inconsistent, write Gregg Fonarow (Ronald Reagan-UCLA Medical Center, Los Angeles, California, USA) and colleagues. They used empiric estimation to quantify the potential benefits that could be gained from eliminating these treatment gaps, and found that a substantial number of annual deaths in the USA could be prevented by optimal implementation of six HF therapies.
These therapies include HF medications such as ACE inhibitors, angiotensin receptor blockers (ARBs), beta blockers, aldosterone antagonists, and hydralazine/isosorbide dinitrate; as well as cardiac resynchronization therapy (CRT), and use of implantable cardioverter-defibrillator devices.
The researchers obtained clinical trial results, in-patient and out-patient registries for HF patients, and HF quality-of-care studies in cardiology and general clinical practice settings. They then determined patient eligibility criteria, frequency of use, fatality rates, and mortality risk-reduction statistics due to treatment, for each evidence-based therapy.
The findings, published in the American Heart Journal, showed that among the 2,644,800 HF patients with reduced LVEF in the USA, the number of patients eligible for treatment but not being currently treated ranged from 139,749 for hydralazine/isosorbide dinitrate to 852,512 for implantable cardioverter defibrillators.
The comparative number of deaths that could potentially be prevented annually was 6516 with optimal implementation of ACE inhibitor/ARB therapy, 12,922 with beta blockers, 21,407 with aldosterone antagonists, 6655 with hydralazine/isosorbide dinitrate, 8317 with CRT, and 12,179 with implantable cardioverter defibrillators.
"If these treatment benefits were additive, optimal implementation of all six therapies could potentially prevent 67,996 deaths a year," say Fonarow et al.
They found that the greatest potential benefits arose from therapies where the treatment gaps and magnitude of benefits were largest. Furthermore, the greatest magnitude of benefit for potential lives saved came from improved use of aldosterone antagonist therapy.
"With tens of thousands of lives potentially saved with optimal application of these therapies, these findings have significant clinical and public health implications," commented Fonarow in a press statement.
"Determining the impact of each evidence-based therapy is helpful in prioritizing performance-improvement initiative efforts and planning future strategies to improve adherence."
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By Piriya Mahendra