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April 5, 2021Journal of Pharmacy Practice

Evaluation of the Usage and Dosing of Guideline-Directed Medical Therapy for Heart Failure With Reduced Ejection Fraction Patients in Clinical Practice

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Why the study?

GDMT is underutilized among eligible patients with HFrEF, but whether this reflects medication intolerance, contraindications, or quality of care issues remains unclear.

Population

500 HFrEF patients enrolled in a quality improvement project at a tertiary center

Design

Quality improvement initiative / observational study

Authors

KSKatelyn SmithBrigham and Women's HospitalJDJacqueline R. DunningBrigham and Women's HospitalCFChristina FischerAnhalt University of Applied Sciences

Discussion

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Implication

Target-dose GDMT under-dosing in HFrEF often lacks documented rationale; hypothesis-generating for quality improvement but should not yet change practice.

Structured PICO

P
Population
500 patients with heart failure with reduced ejection fraction (HFrEF) enrolled in a quality improvement project at a tertiary center (472 subjects with complete data for analysis)
I
Intervention
Guideline-directed medical therapy (ACE inhibitors/Angiotensin Receptor Blockers, Angiotensin Receptor-Neprilysin Inhibitors, beta blockers, and Mineralocorticoid Receptor Antagonists)
O
Outcome
Usage and dosing of 4 categories of guideline-directed medical therapy, and reasons for nonprescription and usage of suboptimal doses

Guideline-directed medical therapy for HFrEF is frequently underutilized and under-dosed in clinical practice, often without documented clinical rationale, highlighting a major opportunity for quality improvement.

Cite This Study

Smith et al. (2021) studied this question.

synapsesocial.com/papers/6a102b199e54838161fddba4https://doi.org/10.1177/08971900211004840

Topics

HFrEF treatmentHeart failureHFpEF management
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Comparative Effects of Low and High Doses of the Angiotensin-Converting Enzyme Inhibitor, Lisinopril, on Morbidity and Mortality in Chronic Heart Failure1999 · 1,248 citations
  2. 2Adherence to Heart Failure Quality-of-Care Indicators in US Hospitals2005 · 271 citations
  3. 3Effect of Enalapril on Survival in Patients with Reduced Left Ventricular Ejection Fractions and Congestive Heart Failure1991 · 8,072 citations
  4. 4Heart Failure Care in the Outpatient Cardiology Practice Setting2008 · 187 citations
  5. 5Phenotyping to Facilitate Accrual for a Cardiovascular Intervention2019 · 7 citations