Improving Evidence-Based Care for Heart Failure in Outpatient Cardiology Practices: Primary Results of IMPROVE HF

Fonarow, Gregg C.; Yancy, Clyde W.; Albert, Nancy M.; Curtis, A.B.; Stough, Wendy Gattis; Gheorghiade, Mihai; Heywood, J. Thomas; McBride, Mark L.; Mehra, Mandeep R.; O'Connor, C.; Reynolds, Dwight; Walsh, M.N.

doi:10.1016/j.cardfail.2009.10.010

Cited by 5 publications

(6 citation statements)

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“…The pre-LVAD use of HF medications in our study appeared lower compared with rates previously documented in patients with clinically stable HF. 22 This was not surprising given that patients with advanced HF are apt to be less tolerant of neurohormonal antagonists. In addition, the overall comorbidity burden of our study population was high, with a significant proportion experiencing concomitant renal, vascular, and pulmonary diseases, which may limit use of HF medications.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have demonstrated that nonadherence to HF treatments is associated with increased risk of hospital readmission and death, and that interventions to improve adherence can improve these outcomes. 6,22,29 Further work is needed to delineate the reasons for nonadherence after LVAD and examine the associations of nonadherence and outcomes.…”

Section: Discussionmentioning

confidence: 99%

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Longitudinal Heart Failure Medication Use and Adherence Following Left Ventricular Assist Device Implantation in Privately Insured Patients

Tan

Sangaralingham

Schilz

et al. 2017

JAHA

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BackgroundThere are few data describing the longitudinal use of and adherence to heart failure medications following left ventricular assist device (LVAD) implantation.Methods and ResultsUsing a large US commercial insurance database, patients who received an LVAD (International Classification of Diseases, 9th Revision, Clinical Modification code 37.66) and survived to hospital discharge without heart transplantation between January 1, 2006, and March 31, 2015, were identified. Heart failure medication use from 3 months before 1‐year post‐LVAD was examined using linked pharmacy claims. Differences in the proportion of patients taking heart failure medications post LVAD compared with pre LVAD were examined using McNemar test. Predictors of post‐LVAD medication use and poor medication adherence (proportion of days covered <0.8) were identified via logistic regression. Among 362 patients (mean age, 57.4 years; 75.1% men), compared with pre LVAD, the proportion of patients taking anticoagulants and antiarrhythmics following LVAD increased; mineralocorticoid receptor antagonists, thiazide diuretics, and digoxin decreased; and β‐blockers, angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, and loop diuretics did not change. Pre‐LVAD medication use was associated with post‐LVAD use across all medication classes. The proportion of patients with poor medication adherence was 28.8%, 39.0%, and 36.0% for β‐blockers, angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, and anticoagulants, respectively. Many patients with poor adherence completely discontinued use of the medication.ConclusionsNeurohormonal antagonist use after LVAD was inconsistent, perhaps reflecting uncertainty of therapeutic benefit in this population. Medication adherence post‐LVAD was poor in many patients. Further work is needed to delineate the reasons for nonadherence after LVAD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Longitudinal Heart Failure Medication Use and Adherence Following Left Ventricular Assist Device Implantation in Privately Insured Patients

Tan

Sangaralingham

Schilz

et al. 2017

JAHA

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“…A similar observation could be made for the downtitration of diuretics: while GPs don't feel comfortable to downtitrate diuretics, cardiologists stated that this should be an important task for the GPs. While it has been demonstrated in several registries and surveys that there is rather a good physician's adherence to ACEI (> 60%) and diuretics (> 80%), the adherence to beta-blockers (BB) and mineralocorticoid receptor antagonists (MRA) was much lower (30 to 60%) [25][26][27][28]. Of interest, it is clear that exclusive use of the percentage of patients treated by guideline-recommended drugs is a poor indicator of the quality of healthcare in HF.…”

Section: Plos Onementioning

confidence: 99%

Diagnosis, treatment, and follow-up of heart failure patients by general practitioners: A Delphi consensus statement

Verhestraeten

Weijers²,

Debleu

et al. 2020

PLoS ONE

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Aims Creation of an algorithm that includes the most important parameters (history, clinical parameters, and anamnesis) that can be linked to heart failure, helping general practitioners in recognizing heart failure in an early stage and in a better follow-up of the patients. Methods and results The algorithm was created using a consensus-based Delphi panel technique with fifteen general practitioners and seven cardiologists from Belgium. The method comprises three iterations with general statements on diagnosis, referral and treatment, and follow-up. Consensus was obtained for the majority of statements related to diagnosis, referral, and follow-up, whereas a lack of consensus was seen for treatment statements. Based on the statements with good and perfect consensus, an algorithm for general practitioners was assembled, helping them in diagnoses and follow-up of heart failure patients. The diagnosis should be based on three essential pillars, i.e. medical history, anamnesis and clinical examination. In case of suspected heart failure, blood analysis, including the measurement of NT-proBNP levels, can already be performed by the general practitioner followed by referral to the cardiologist who is then responsible for proper diagnosis and initiation of treatment. Afterwards, a multidisciplinary health care process between the cardiologist and the general practitioner is crucial with an important role for the general practitioner who has a key role in the up-titration of heart failure medication, down-titration of the dose of diuretics and to assure drug compliance. Conclusions Based on the consensus levels of statements in a Delphi panel setting, an algorithm is created to help general practitioners in the diagnosis and follow-up of heart failure patients.

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“…Of vital concern is the continuing impact of a national educational program sponsored to increase CRT in selected sites, where use has already increased by 66%. 8 Specifically, the analyses in this issue of the Archives challenge us to reevaluate our approach to CRT. To continue to perform this procedure when benefit is unlikely will undermine enthusiasm for a remarkably effective therapy in appropriate patients.…”

mentioning

confidence: 98%

“…The recommendation for CRT implantation in all symptomatic patients with low ejection fraction and QRS intervals greater than 120 milliseconds has already been positioned as such a quality measure. 8 Thus, those experienced practitioners who have recognized the poor response after CRT with QRS intervals in the 120-to 150-millisecond range might be penalized for their clinical acumen when they withhold CRT from those patients unlikely to benefit. Of vital concern is the continuing impact of a national educational program sponsored to increase CRT in selected sites, where use has already increased by 66%.…”

mentioning

confidence: 99%

“A Little Learning Is a Dangerous Thing”

Stevenson

2011

Arch Intern Med

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Improving Evidence-Based Care for Heart Failure in Outpatient Cardiology Practices: Primary Results of IMPROVE HF

Cited by 5 publications

References 0 publications

Longitudinal Heart Failure Medication Use and Adherence Following Left Ventricular Assist Device Implantation in Privately Insured Patients

Longitudinal Heart Failure Medication Use and Adherence Following Left Ventricular Assist Device Implantation in Privately Insured Patients

Diagnosis, treatment, and follow-up of heart failure patients by general practitioners: A Delphi consensus statement

“A Little Learning Is a Dangerous Thing”

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