Comparison of medical therapy dosing in outpatients cared for in cardiology practices with heart failure and reduced ejection fraction with and without device therapy: report from IMPROVE HF

Circulation. Heart Failure
J Thomas HeywoodMary Norine Walsh

Abstract

Few data exist to characterize the delivery of evidence-based medical therapy for outpatients with heart failure who have received implantable cardioverter-defibrillators or cardiac resynchronization therapy (CRT) for systolic dysfunction. IMPROVE HF is a prospective study characterizing the management of 15 381 outpatients with systolic heart failure (left ventricular ejection fraction ≤35%) enrolled from 167 US cardiology practices. Data were abstracted for dose, type, and daily frequency for angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, and aldosterone antagonists. Target doses for each medication class were based on current guidelines. Patients with devices (implantable cardioverter-defibrillators, CRT with defibrillators, or CRT with pacemakers) more frequently received evidence-based medical therapy than did those without such devices, although treatment at or above target doses was low for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (implantable cardioverter-defibrillators 32.6%, CRT with pacemaker 30.7%, CRT with defibrillator 32.0%, no device 34.6%) and β-blockers (20.2%, 17.4%, 20.4%, and 15.3%, respectively). Fewer patients received aldosterone antagon...Continue Reading

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