Most patients with heart failure with reduced ejection fraction (HFrEF) did not receive target doses of medical therapy during follow-up and few patients had dose increases over time in an analysis of the CHAMP-HF registry, released March 4 in the Journal of the American College of Cardiology which will be presented during ACC.19 in New Orleans, LA.

Current guidelines for patients with HFrEF recommend the use of multiple evidence-based medications titrated to the target dose from landmark clinical trials, as tolerated. The aim of this analysis, reported by Stephen J. Greene, MD, et al., was to assess the practice patterns of longitudinal titration of guideline-directed medical therapy in routine U.S. clinical practice, clinical factors associated with dose increases and decreases, and underlying reasons for medication changes.

The CHAMP-HF was a prospective observational study of patients with HFrEF receiving ≥1 HF medication at enrollment. Four medication classes were evaluated in 2,588 eligible patients: angiotensin-converting enzyme inhibitors (ACEI)/angiotensin II receptor blockers (ARB), angiotensin receptor-neprilysin inhibitors (ARNI), evidence-based beta blockers and mineralocorticoid receptor antagonists (MRA). The use and dose of the medications were assessed at baseline and 12-months follow-up.

At baseline, the percentage of patients receiving target doses for beta-blocker, ACEI/ARB, MRA and ARNI were 20.3, 11.1, 25.4 and 1.7 percent, respectively. At 12 months, rates of medication initiation or dose increase were 7.0, 9.9, 9.9 and 6.3 percent for ACEI/ARB, ARNI, beta-blocker and MRA, respectively. Rates of discontinuation and dose decrease were 11.5, 2.5, 6.6 and 4.4 percent for ACEI/ARB, ARNI, beta-blocker and MRA, respectively.

"Further quality improvement efforts are urgently needed to improve guideline-directed medication titration in routine practice," the authors conclude.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure, Heart Failure and Cardiac Biomarkers

Keywords: ACC19, ACC Annual Scientific Session, Mineralocorticoid Receptor Antagonists, Neprilysin, Prospective Studies, Quality Improvement, Stroke Volume, Adrenergic beta-Antagonists, Heart Failure, Angiotensin Receptor Antagonists, Ventricular Dysfunction, Left, Angiotensin-Converting Enzyme Inhibitors, Receptors, Angiotensin

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