Elsevier

JACC: Heart Failure

Volume 7, Issue 1, January 2019, Pages 13-21
JACC: Heart Failure

Mini-Focus Issue: Drug Therapy
Clinical Research
Contemporary Drug Treatment of Chronic Heart Failure With Reduced Ejection Fraction: The CHECK-HF Registry

https://doi.org/10.1016/j.jchf.2018.10.010Get rights and content
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Abstract

Objectives

This study investigated adherence to drug therapy guidelines in heart failure (HF) with reduced left-ventricular ejection fraction (LVEF) of <40% (heart failure with reduced ejection fraction [HFrEF]), in which evidence-based treatment has been established.

Background

Despite previous surveys of HF, important uncertainties remain regarding guideline adherence in a representative real-world population.

Methods

A cross-sectional registry in 34 Dutch HF outpatient clinics that included 10,910 patients with the diagnosis of HF was examined. Of that number, 8,360 patients had LVEF <50% (72 ± 12 years of age; 64% male) and were divided into HFrEF (n = 5,701), HF with mid-range LVEF (HFmrEF) with LVEF 40% to 49% (n = 1,574), and those with semiquantitatively measured LVEF but <50% (n = 1,085).

Results

In the HFrEF group, 81% of the patients were treated with loop diuretics, 84% with renin-angiotensin-system (RAS) inhibitors, 86% with β-blockers, 56% with mineralocorticoid-receptor antagonists (MRA), and 5% with If-channel inhibition. Differences in medication use were minor among the 3 groups but were significant among centers. Inability to tolerate the medications was recorded in 9.4% patients taking RAS inhibitors, 3.3% taking β-blockers, and 5.4% taking MRAs. Median loop diuretic dose was 40 mg of furosemide equivalent, RAS inhibitor dose 50% of target, β-blocker dose 25% of target, and MRA dose 12.5 mg of spironolactone equivalent. Elderly patients were treated predominantly with diuretics and less often with RAS inhibitors, β-blockers, and MRAs.

Conclusions

This large contemporary HF registry showed a relatively high use of evidence-based treatment, particularly in younger patients. However, the average dose of evidence-based medication was still lower than recommended by guidelines. Furthermore, the more recently introduced If-channel inhibition has hardly been adopted. There is ample room for improvement of HFrEF therapy, even more than 25 years after convincing evidence that HFrEF treatment leads to better outcome.

Key Words

guideline adherence
heart failure
HFrEF
reduced ejection fraction
registry
treatment

Abbreviations and Acronyms

ACE
angiotensin-converting enzyme
ARB
angiotensin receptor blocker
HF
heart failure
HFmrEF
heart failure with mid-range ejection fraction
HFpEF
heart failure with preserved ejection fraction
HFrEF
heart failure with reduced ejection fraction
LVEF
left-ventricular ejection fraction
MRA
mineralocorticoid receptor antagonist
RAS
renin-angiotensin system

Cited by (0)

Data inclusion and software were supported by Servier. There was no funding source for analysis, data interpretation, and writing of the manuscript. Dr. Brunner-La Rocca has received research grants from Roche Diagnostics, Novartis, and Vifor. Dr. van de Kamp is an employee of Servier. All other authors have reported that they had no relationships relevant to the contents of this paper to disclose.