Care in a specialized heart failure program significantly increased the utilization of ACE inhibitors and angiotensin-receptor blockers from 87% to 100% (p<0.001).
Observational (n=133)
Does care in a specialized heart failure program improve the utilization and dosage of cardiovascular drugs in patients with chronic heart failure?
Care in a specialized heart failure program significantly increases the utilization and dosage of guideline-directed medical therapies, particularly ACE inhibitors.
Absolute Event Rate: 100% vs 87%
p-value: p=< 0.001
BACKGROUND: Utilization and dosage of angiotensin-converting enzyme (ACE) inhibitors in patients with chronic heart failure (CHF) remain low. Recent data suggest that care of patients with CHF in specialized heart failure programs is associated with improved clinical outcomes. HYPOTHESIS: Specialized heart failure care is associated with better utilization and higher dose of cardiovascular drugs. METHODS: Data from 133 patients with CHF referred to a heart failure program were analyzed. Mean functional class 3.1 +/- 0.5, left ventricular ejection fraction 19 +/- 8. Utilization and doses of cardiovascular drugs were examined at initial evaluation and at last visit, after an average period of 17 +/- 14 months. Hospitalization and survival data were determined. RESULTS: Utilization of ACE inhibitors and angiotensin-receptor blockers increased from 87 to 100% (p < 0.001). Average daily dose increased by 60%, from the equivalent of captopril 105 +/- 78 mg to 167 +/- 86 mg (p < 0.001). Utilization of the following drugs increased significantly: beta blockers (16-37%, p < 0.001), metolazone (10-23%, p = 0.007), spironolactone (1-36%, p < 0.001), amiodarone (7-15%, p = 0.05), hydralazine (1-9%, p = 0.004), and nitrates (20-33%, p = 0.03). One-year survival was 90%. The 3- and 6-month hospitalization rates for heart failure were 4 and 7%, and for all cardiovascular causes they were 6 and 11%, respectively. CONCLUSIONS: Care of patients with CHF in a specialized heart failure program was associated with significant increase in the utilization and doses of all beneficial cardiovascular drugs, especially ACE inhibitors. It was also associated with excellent clinical outcomes.
Ramahi et al. (Fri,) conducted a observational in Chronic heart failure (n=133). Specialized heart failure program vs. Initial evaluation (baseline) was evaluated on Utilization of ACE inhibitors and angiotensin-receptor blockers (p=< 0.001). Care in a specialized heart failure program significantly increased the utilization of ACE inhibitors and angiotensin-receptor blockers from 87% to 100% (p<0.001).