JAMA: Recommended treatment for heart failure often underused

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Less than one-third of patients hospitalized for heart failure (HF) and participating in a quality improvement registry received a guideline-recommended treatment, aldosterone antagonist therapy, according to a study in the Oct. 21 issue of the Journal of the American Medical Association.

Clinical trials have established the benefits of aldosterone antagonist therapy in HF patients, 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 program is a national quality improvement program designed to promote adherence to guideline-based recommendations,” the authors wrote. “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.”

Nancy M. Albert, PhD, RN, of the Cleveland Clinic, and colleagues examined recent aldosterone antagonist use among hospitalized HF patients, 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 32.5 percent received an aldosterone antagonist at hospital discharge, according to the researchers. Treatment increased modestly from 28 percent to 34 percent over the study period. There was also wide variation in aldosterone antagonist use among hospitals (0-90.6 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, pacemaker implantation and with having no history of renal insufficiency,” the authors wrote.

Albert and colleagues said that applying certain appropriateness criteria, inappropriate and potentially inappropriate use of aldosterone antagonist therapy was low and did not change over the three-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,” the researchers concluded. “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.”