Recommended treatment for heart failure often underused

Oct 20, 2009

Less than one-third of patients hospitalized for heart failure and participating in a quality improvement registry received a guideline-recommended treatment of heart failure, aldosterone antagonist therapy, according to a study in the October 21 issue of JAMA.

Clinical trials have established the benefits of aldosterone antagonist therapy (an agent that opposes the action of the adrenal hormone aldosterone) in patients with (HF), such that they were designated as "useful and recommended," within the American College of Cardiology/American Heart Association (ACC/AHA) Chronic HF Guidelines. Adoption of aldosterone antagonists for treatment of HF has been mixed, according to background information in the article.

"The Get With The Guidelines-HF (GWTG-HF) program is a national quality improvement program designed to promote adherence to guideline-based recommendations. It is unknown whether participation in a hospital-based quality program may lead to greater frequency of use of aldosterone antagonist therapy for appropriate indications as well as lower use in situations of increased risk," the authors write.

Nancy M. Albert, Ph.D., R.N., of the Cleveland Clinic, Cleveland, and colleagues examined recent aldosterone antagonist use among hospitalized patients with HF, as well as temporal trends and appropriateness of use. The observational analysis included 43,625 patients admitted with HF and discharged home from 241 hospitals participating in the Get With The Guidelines-HF quality improvement registry between 2005-2007.

In total, 12,565 patients (28.8 percent) from 201 hospitals met ACC/AHA management guidelines criteria, and 4,087 eligible patients (32.5 percent) received an aldosterone antagonist at hospital discharge. Treatment increased modestly from 28 percent to 34 percent over the study period. There was also wide variation in aldosterone antagonist use among hospitals (0 percent-90.6 percent).

"Aldosterone antagonist use in eligible patients was associated with younger age, African American race/ethnicity, lower systolic blood pressure, history of implantable cardioverter-defibrillator use, depression, alcohol use, and pacemaker implantation, and with having no history of renal insufficiency," the authors write. Applying certain appropriateness criteria, inappropriate and potentially inappropriate use of aldosterone antagonist therapy was low and did not change over the 3-year study period.

"These data confirm that in the context of a hospital-based performance improvement program, aldosterone antagonist therapy can be used according to guidelines with little inappropriate use. Given the substantial morbidity and mortality risk faced by patients hospitalized with HF and the established efficacy of aldosterone antagonist prescription in HF, a stronger uptake of aldosterone antagonist therapy indicated by evidence-based guidelines may be warranted," the researchers conclude.

More information: JAMA. 2009;302[15]:1658-1665

Source: JAMA and Archives Journals (news : web)

Explore further: Senegal monitors contacts of 1st Ebola patient

add to favorites email to friend print save as pdf

Related Stories

New target for heart failure therapy identified

Mar 16, 2009

A novel signaling pathway plays a significant role in the production of aldosterone, a hormone that promotes heart failure after a myocardial infarction, according to a study conducted by Thomas Jefferson University researchers.

Heart failure: Women different than men

Jul 27, 2009

Striking differences in the risk factors for developing heart failure (HF) and patient prognosis exist between men and women. Men and women may also respond differently to treatment, raising concerns about whether current ...

Heart failure linked to cognitive impairment

Feb 05, 2009

Nearly half of patients with heart failure (HF) have problems with memory and other aspects of cognitive functioning, reports a new study published by Elsevier, in the February issue of Journal of Cardiac Failure .

Depression after heart disease ups risk of heart failure

Apr 13, 2009

Patients with heart disease who are subsequently diagnosed with depression are at greater risk for heart failure (HF), a condition in which the heart can't pump enough blood throughout the body, according to a new study published ...

New method assesses risks for heart failure patients

Jul 30, 2008

Data from 260 hospitals across the United States has led to the creation of a new method for physicians to more accurately determine the severity of heart failure in patients upon hospital admission, with a goal of reducing ...

Recommended for you

Senegal monitors contacts of 1st Ebola patient

1 hour ago

Senegalese authorities on Monday were monitoring everyone who was in contact with a student infected with Ebola who crossed into the country, and who has lost three family members to the disease.

Cerebral palsy may be hereditary

7 hours ago

Cerebral palsy is a neurological developmental disorder which follows an injury to the immature brain before, during or after birth. The resulting condition affects the child's ability to move and in some ...

19 new dengue cases in Japan, linked to Tokyo park

13 hours ago

Japan is urging local authorities to be on the lookout for further outbreaks of dengue fever, after confirming another 19 cases that were contracted at a popular local park in downtown Tokyo.

User comments : 0