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Influence of renal function on the use of guideline-recommended therapies for patients with heart failure.

Publication ,  Journal Article
Heywood, JT; Fonarow, GC; Yancy, CW; Albert, NM; Curtis, AB; Stough, WG; Gheorghiade, M; McBride, ML; Mehra, MR; O'Connor, CM; Reynolds, D; Walsh, MN
Published in: Am J Cardiol
April 15, 2010

Guidelines have been established for the treatment of patients with heart failure (HF) and left ventricular dysfunction, but renal dysfunction might limit adherence to these guidelines. Few data have characterized the use of guideline-recommended therapy for patients with HF, left ventricular dysfunction, and renal dysfunction who are treated in outpatient settings. The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) was a prospective study of patients receiving treatment as outpatients in cardiology practices in the United States. The rates of adherence to 7 guideline-recommended therapies were evaluated for patients with a left ventricular ejection fraction of < or = 35%. The estimated glomerular filtration rate was estimated using the Modification of Diet in Renal Disease formula for 13,164 patients who were categorized as having stage 1 through stage 4/5 chronic kidney disease (CKD). More than 1/2 (52.2%) of the patients had stage 3 or 4/5 CKD. Older patients and women were at increased risk of higher stage CKD, and the rates of co-morbid health conditions were significantly greater among patients with more severe CKD. The patients with more severe CKD were significantly less likely to receive all interventions except cardiac resynchronization therapy. However, multivariate analysis controlling for patient characteristics revealed that the severity of CKD was an independent predictor of adherence to angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy but not to any of the 6 other guideline-recommended measures. In conclusion, these results confirm that CKD is common in patients with HF and left ventricular dysfunction but is not independently associated with adherence to guideline-recommended therapy in outpatient cardiology practices, with the exception of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy.

Duke Scholars

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

April 15, 2010

Volume

105

Issue

8

Start / End Page

1140 / 1146

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Ventricular Dysfunction, Left
  • Stroke Volume
  • Renal Insufficiency
  • Prospective Studies
  • Prognosis
  • Practice Guidelines as Topic
  • Outpatients
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Heywood, J. T., Fonarow, G. C., Yancy, C. W., Albert, N. M., Curtis, A. B., Stough, W. G., … Walsh, M. N. (2010). Influence of renal function on the use of guideline-recommended therapies for patients with heart failure. Am J Cardiol, 105(8), 1140–1146. https://doi.org/10.1016/j.amjcard.2009.12.016
Heywood, J Thomas, Gregg C. Fonarow, Clyde W. Yancy, Nancy M. Albert, Anne B. Curtis, Wendy Gattis Stough, Mihai Gheorghiade, et al. “Influence of renal function on the use of guideline-recommended therapies for patients with heart failure.Am J Cardiol 105, no. 8 (April 15, 2010): 1140–46. https://doi.org/10.1016/j.amjcard.2009.12.016.
Heywood JT, Fonarow GC, Yancy CW, Albert NM, Curtis AB, Stough WG, et al. Influence of renal function on the use of guideline-recommended therapies for patients with heart failure. Am J Cardiol. 2010 Apr 15;105(8):1140–6.
Heywood, J. Thomas, et al. “Influence of renal function on the use of guideline-recommended therapies for patients with heart failure.Am J Cardiol, vol. 105, no. 8, Apr. 2010, pp. 1140–46. Pubmed, doi:10.1016/j.amjcard.2009.12.016.
Heywood JT, Fonarow GC, Yancy CW, Albert NM, Curtis AB, Stough WG, Gheorghiade M, McBride ML, Mehra MR, O’Connor CM, Reynolds D, Walsh MN. Influence of renal function on the use of guideline-recommended therapies for patients with heart failure. Am J Cardiol. 2010 Apr 15;105(8):1140–1146.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

April 15, 2010

Volume

105

Issue

8

Start / End Page

1140 / 1146

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Ventricular Dysfunction, Left
  • Stroke Volume
  • Renal Insufficiency
  • Prospective Studies
  • Prognosis
  • Practice Guidelines as Topic
  • Outpatients
  • Middle Aged
  • Male