Among HFrEF patients who worsen, medication rates are low before and after event

Takeaway

• Among patients with initially stable heart failure and reduced ejection fraction (HFrEF) who develop worsening chronic heart failure (HF), most are not receiving recommended therapy, and continue not to receive it months after the event.
• Editorial: “the precise degree to which low medication use represents an opportunity for improvement in the community versus the reality of physiological tolerability, is unclear.”

Why this matters

• Clinical course of worsening chronic HF among patients with HFrEF is little described.

Key results

• 16.7% (1851) patients developed worsening chronic HF.
  • 2-year mortality: 22.5%.
  • 56%-70% had HF-related hospitalisations in 2 subsequent years.
• Before worsening event, rates of beta-blocker, mineralocorticoid receptor antagonists, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blocker use:
  • Triple therapy: 13.7%,
  • Dual therapy: 34.1%,
  • Monotherapy: 33.7%, and
  • None of the 3: 18.6%.
• Drug patterns similar 6 months after worsening event.

​Study design

• Analysis of adults with newly-diagnosed HFrEF in a US national cardiovascular data registry and linked databases, 2010-2016 (n=11,064).
• For patients with worsening HF (≥90 days of stable HF, then worsening requiring intravenous diuretics), authors assessed characteristics, hospitalisations, mortality.
• Funding: Merck & Co., Inc., Kenilworth, NJ, USA.

Limitations

• Reasons for suboptimal treatment unknown.
• Some deaths may not have been captured.