Heart Failure Patients are not Receiving Evidence-Based Lifesaving Drug Therapy: Lessons from the Heart Failure Adherence and Retention Trial (HART)

摘要

Heart failure prevalence is growing. Evidence-based drug therapies that improve longevity and reduce hospitalizations have been identified but they are underutilized. HART tested the hypothesis that counseling in self-management skills plus education would be superior to education alone in reducing death or heart failure hospitalizations in patients with mild to moderate heart failure. The purpose of this report was to assess both physician and patient non-adherence to evidence-based therapy at the HART baseline in the 694 patients with systolic dysfunction. This cohort was 50% female, 42% minority, 31% NYHA Class III, 75% hypertensive, 41% diabetic, 43% with a previous myocardial infarction, and an average of 3.2 comorbidities. By self-report, 86% were prescribed an ACE inhibitor or ARB and 71% were prescribed a beta-blocker. Physician adherence to evidence-based guidelines was assessed using an algorithm to determine, for each patient, prescription of a beta blocker, an ACE inhibitor or ARB, blood pressure control, and statin therapy (for patients with coronary artery disease). Contraindications were embedded in the algorithm. Patient adherence was assessed by MEMS electronic pill caps. Results are that 53% of the physicians were not prescribing all indicated evidence-based therapy and 37% of the patients were not taking their pills as prescribed. We conclude that an alarming number of heart failure patients are not receiving life-saving drug therapy due either to physician or patient non-adherence.