Improvement in the management of chronic heart failure since the publication of the updated guidelines of the European Society of Cardiology
The Impact-Reco Programme
1 Pôle de Cardiologie et Maladies Vasculaires, CHRU de Lille, Université de Lille 2, France
2 Department of Cardiology, Université Pierre et Marie Curie–Paris VI, AP-HP, Pitie Salpetriere Hospital, 75651 Paris Cedex 13, France
3 Orgamétrie, Roubaix, France
4 Service de Cardiologie, Hôpital Bichat, AP-HP, Université Denis Diderot, Paris VII, Paris, France
5 Fédération des Services de Cardiologie, CHU Rangueil, Toulouse, France
6 Services de Cardiologie, Hôpital Saint Antoine, Paris, France
7 Astra-Zeneca, Rueil-Malmaison, France
8 Institut Cœur Effort Santé, Paris, France
9 Centre Alfred Kastler, Sarcelles, France
* Corresponding author. Tel: +33 1 4216 3003, Fax: +33 1 4216 3020, Email: michel.komajda{at}psl.ap-hop-paris.fr
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Abstract |
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Aims: Recent studies have shown that prescription rates and doses of recommended drugs for chronic heart failure (CHF) are not optimal in daily practice. The aim of the Impact-Reco programme was to analyse prescription rates of CHF drugs in stable outpatients with CHF related to left ventricular (LV) systolic dysfunction in two similar surveys in France.
Methods and results: The two surveys, which included 1917 and 1974 patients, were performed between September 2004 to March 2005 and September 2005 to May 2006, respectively. Prescription rates of angiotensin-converting enzyme-inhibitors (ACE-I) remained stable (71 vs. 68%, respectively), whereas the proportion of patients receiving angiotensin receptor blockers (21 vs. 30%, P < 0.0001) and beta-blockers (65 vs. 70% P < 0.0001) increased significantly. Doses of ACE-I and beta-blockers increased significantly between the two surveys. However, the improvement was of lesser magnitude in some subgroups of patients, such as elderly patients or patients with renal failure.
Conclusion: The Impact-Reco programme found an improvement in prescription rates and in the dosage of neurohumoral antagonists in French outpatients with stable CHF. However, there is still room for improvement, especially regarding the doses of medications and the treatment of some subgroups of patients such as the elderly and patients with renal failure.
Key Words: Chronic heart failure • Drug prescription • Angiotensin-converting enzyme-inhibitors • Beta-blockers • Angiotensin 2 receptor blockers • Guidelines
Received February 4, 2008; Revised August 17, 2008; Accepted August 22, 2008
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