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Treatment of patients with chronic heart failure: does management in heart failure clinic improve adherence to guidelines for the treatment of heart failure?

Session Poster Session 3

Speaker Tjasa Furlan

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure: Pharmacotherapy
  • Session type : Poster Session

Authors : T Furlan (Trbovlje,SI), D Kosuta (Trbovlje,SI), V Grilj (Trbovlje,SI), S Poznic (Trbovlje,SI), B Leskovar (Trbovlje,SI)

Authors:
T Furlan1 , D Kosuta1 , V Grilj1 , S Poznic1 , B Leskovar1 , 1Trbovlje General Hospital, Department of Internal Medicine - Trbovlje - Slovenia ,

Citation:

Background. Despite major advances in treatment options for heart failure patients, studies show that they remain undertreated. 

Purpose. The aim of our study was to evaluate the therapeutic management of heart failure in our outpatient heart failure clinic.

Methods. We retrospectively evaluated all patients that were treated in our outpatient heart failure clinic between January 2017 and December 2018. We compared the number of patients receiving angiotensin receptor-neprilysin inhibitors (ARNI), angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARB), beta blockers and mineralocorticoid receptor antagonists (MRA) before being managed in the heart failure clinic and at last clinic follow-up with independent samples t-test.

Results. We evaluated 215 patients with heart failure; 84 patients (39%) had heart failure with reduced ejection fraction (HFrEF), 35 patients (16%) had heart failure with mid-range ejection fraction (HFmrEF) and 96 patients (45%) had heart failure with preserved ejection fraction (HFpEF).
In HFrEF group, 14% of patients were treated with ARNI (4% were receiving target doses), 65% with ACEi/ARB (26% on target doses), 92% with beta blockers (45% on target doses) and 51% with MRA (2% on target doses). After a mean period of 8.5±6.7 months, 29% of HFrEF patients were treated with ARNI (p=0.000; target dose 23%, p=0.001), 61% with ACEi/ARB (p=0.397; target dose 36%, p=0.073), 96% with beta blockers (p=0.103; target dose 60%, p=0.01), 54% with MRA (p=0.47; target dose 11%, p=0.708).
In HFmrEF group 69% of patients were treated with ACEi/ARB (31% on target doses) and 83% with beta blockers (40% on target doses). After a mean period of 7.1±5.4 months, 83% of patients with HFmrEF were treated with ACEi/ARB (p=0.023; target dose 43%, p=0.044) and 89% with beta blockers (p=0.16; target dose 51%, p=0.044).
In HFpEF group 77% of patients were treated with ACEi/ARB (45% on target doses) and 89% with beta blockers (35% on target doses). After a mean period of 8.6±5.7 months, 83% of patients with HFpEF were treated with ACEi/ARB (p=0.134; target dose 55%, p=0.041) and 89% with beta blockers (p=0.16; target dose 51%, p=0.044).

Conclusions. Our data suggests that current guidelines for the treatment of heart failure are still not being reflected in clinical practice, especially if patients are not managed in heart failure clinic. With outpatient management in a dedicated heart failure clinic, medication can be titrated in a relatively short period of time and better adherence to the guidelines can be achieved despite possible side effects that can be overcome with frequent patient monitoring.

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