CHECK-HF: Guideline-recommended Drug Therapy for HFrEF Generally High

While the use of evidence-based drug therapy for heart failure (HF) is high, there are still areas for improvement, a new analysis of the CHECK-HF Registry suggests.

Researchers performed the study using cross-sectional data from 34 Dutch outpatient clinics that included 10,190 patients with heart failure diagnoses. Patients with left ventricular ejection fraction (LVEF) <50% (n=8,360) were divided into HF with reduced ejection fraction (HFrEF; =5,701), HF with mid-range LVEF (HFmrEF) with LVEF between 40% and 49% (n=1,574), and patients with semiquantitatively measured LVEF but less than 50% (n=1,085).

Despite 25 years of convincing evidence, substantial room for improvement in Dutch prescription of outpatient #HFrEF therapy; real-world evidence: https://t.co/J2aOLqyCnY #JACCHF @MaastrichtU pic.twitter.com/NKz81wdSyU

— JACC Journals (@JACCJournals) January 21, 2019

The results showed that 81% of the HFrEF patients were treated with a loop diuretic, 84% treated with renin-angiotensin-system (RAS) inhibitors, 86% with beta-blockers, 56% with mineralocorticoid-receptor antagonists, and 5% with I_f-channel inhibitors. The media loop diuretic dose was 40 mg furosemide equivalent, RAS inhibitor dose at 50% of target, beta-blockers at 25%, and MRA dose of 12.5 mg spironolactone equivalent.

https://twitter.com/bmorecardiology/statuses/1084837421936713729

“This large contemporary HF registry showed a relatively high use of evidence-based treatment, particularly in younger patients,” the researchers wrote in their conclusion. “However, the average dose of evidence-based medication was still lower than recommended by guidelines. Furthermore, the more recently introduced I_f-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.”

Contemporary Drug Treatment of Chronic Heart Failure With Reduced Ejection Fraction, The CHECK-HF Registry
This study showed a high use of evidence-based HF treatment. Better adoption could result in a substantial reduction in HF deaths https://t.co/ChVSoBtV95 pic.twitter.com/2BX71syxm6

— Edward NS (@EdwMD) January 10, 2019

In an accompanying editorial, Stephen J. Greene, MD, and C. Michael Felker, MD, implored that the urgency of treating HFrEF should have as much a sense of urgency as treating cancers.

#HeartFailure therapy in a nutshell: "Short term symptomatic relief is achieved readily using loop diuretics, potentially distracting from use of guideline-directed medical therapies proven to improve survival and quality of life." @JACCJournals https://t.co/A7hbikVAew

— Cia Connell (@CiaConnell) January 2, 2019

“In comparison with cancer, the care of HFrEF does not elicit the same sense of urgency among patients, families, or clinicians,” they wrote. “HF patients, and clinicians have been shown to be overly optimistic in their estimates of survival.”

https://twitter.com/ATRIUMRx/statuses/1083060333126676480

Adding a sense of urgency to outpatient medical therapy for #heartfailure w/ reduced EF. Outcomes for chronic HFrEF and many cancers remarkably similar, perception & culture of medical care remarkably different. @DukeHFDoc @DCRINews @JACCJournals #JACCHFhttps://t.co/FOVUpFbg1N pic.twitter.com/lt5QW0YMl7

— Steve Greene (@SJGreene_md) December 31, 2018

Source: JACC Heart Failure