Key result
In outpatients with chronic heart failure in the Moscow Region, while 83.2% received RAAS blockers and 79.0% received beta-blockers, the prescribed doses were frequently below international guideline recommendations.
Why the study?
To characterize patients with chronic heart failure in the Moscow Region and assess whether their current treatments meet clinical guidelines.
Cross-Sectional (n=286)
Yes
There is a significant gap between real-world heart failure management and international clinical guidelines, particularly regarding target medication doses.
Underdosing of GDMT in HF outpatients may limit benefits; hypothesis-generating for interventions to achieve target doses.
Aim: To perform clinical characterization of patients with chronic heart failure (CHF) in the Moscow Region and to assess if their current treatments meet the current clinical guidelines. Materials and methods: Based on the information submitted from 11 outpatient clinics in the Moscow Region in December 2019, we analyzed retrospective data on 286 patients with CHF, including their concomitant diseases, types of assessments and their results, as well as current treatments. Results: The most common concomitant disease was arterial hypertension (95.1% of the patients). 53.8% of the patients had previous myocardial infarction, 37.8%, diabetes mellitus, and 34.6%, atrial fibrillation. Chronic kidney disease was present in 18.5% of the patients, valvular heart disease in 11.9%, and past stroke in 10.5%. Of non-cardiovascular diseases, the most common were gastrointestinal disorders (25.2%), chronic obstructive pulmonary disease or asthma (9.8%), and anemia (5.2%). Only 8% of the patients had one concomitant disease, whereas 72% had 2 to 3 diseases, and 20% had at least 4 concomitant diseases. Mean number of comorbidities per patient was 2.7. Echocardiography had been performed in 82.9% of the cases. Mean left ventricular ejection fraction was 51.0±10.11%; in 11.5% of the patients it was≤40%. Glomerular filtration rate (GFR) was calculated in 58.7% of the patients. 35.9% of the patients had a GFR of less than 60 mL/min/1.73 m2 , in 3.6% it was≤30 mL/min/1.73 m2 . 83.2% of the patients were treated with renin angiotensin aldosterone system blockers (angiotensin-converting enzyme inhibitors, angiotensin receptor antagonists, sacubitril/valsartan), 79.0% with beta-blockers, 53.1% with mineralocorticoid receptor antagonists. Glycosides had been administered to 6.9% of the patients, and diuretics, to 51.1%. In most cases, the doses administered were below those recommended by the international clinical guidelines. Conclusion: We have confirmed the need to increase the adherence of doctors to the clinical guidelines on assessment and management of CHF patients.
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Chernyavskaya et al. (2021) conducted a cross-sectional in Chronic heart failure (n=286). Current medical therapy for chronic heart failure vs. Clinical guideline recommendations was evaluated on Proportion of patients receiving guideline-directed medical therapy and target doses. In outpatients with chronic heart failure in the Moscow Region, while 83.2% received RAAS blockers and 79.0% received beta-blockers, the prescribed doses were frequently below international guideline recommendations.
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