© 2007 European Society of Cardiology
Is the gap between guidelines and clinical practice in heart failure treatment being filled? Insights from the IMPACT RECO survey
a Service de Cardiologie C, Hôpital Cardiologique CHRU, Bd du Pr Jules Leclercq, 59037 Lille Cedex, France
b Département de Cardiologie, Hôpital Pitié-Salpêtrière & Université Pierre et Marie Curie Paris, France
c Service Cardiologie, Hôpital Saint Antoine Paris, France
d Orgametrie Roubaix, France
e Institut Cœur Effort Santé Paris, France
f Fédération des Services de Cardiologie CHU Rangueil, Toulouse, France
g Service de Cardiologie, Hôpital Ambroise Paré Boulogne, France
h AstraZeneca Rueil-Malmaison, France
i Centre Alfred Kassler Sarcelles, France
* Corresponding author. Tel.: +33 3 20445045; fax: +33 3 20444881. pdegroote{at}chru-lille.fr (P. de Groote).
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Abstract |
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Background: Recent registries have shown that recommended drugs for the treatment of chronic heart failure (CHF) are under-prescribed in daily practice.
Aims: To determine prescription rates of CHF drugs, and to assess predictive factors for drug prescription using data from a large panel of French cardiologists.
Methods and results: We included 1919 outpatients, with NYHA class II–IV heart failure and a left ventricular ejection fraction <40%. The most frequently prescribed drugs were diuretics (83%), angiotensin converting enzyme inhibitors (ACE-I) (71%), beta-blockers (65%), spironolactone (35%) and angiotensin receptor blockers (ARB) (21%); 61% of patients received a combination of a beta-blocker and an ACE-I or ARB. Target doses were reached in 49% of the patients for ACE-I, but in only 18% for beta-blockers and in 9% for ARBs. Multivariate analyses showed that age >75 years was an independent factor associated with under-prescription of ACE-I-ARBs, beta-blockers or spironolactone. Renal failure was associated with a lower prescription of ACE-I-ARB and spironolactone, and asthma was a predictor of under-prescription of beta-blockers.
Conclusions: In this contemporary survey, prescription rates of CHF drugs were higher than previously reported. However, dosages were lower than those recommended in guidelines. Age remained an independent predictor of under-prescription of CHF drugs.
Key Words: Chronic heart failure • Drug prescription • Angiotensin converting enzyme inhibitors • Beta-blockers • Angiotensin 2 receptor blockers
Received March 12, 2007; Revised July 9, 2007; Accepted September 25, 2007
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