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Is heart failure guideline adherence being underestimated? The impact of therapeutic contraindications.

Publication ,  Journal Article
Atwater, BD; Dai, D; Allen-Lapointe, NM; Al-Khatib, SM; Zimmer, LO; Sanders, GD; Peterson, ED
Published in: Am Heart J
November 2012

BACKGROUND: Several studies based on claims data have reported underutilization of evidence-based heart failure (HF) therapies. The degree to which these estimates fail to account for therapeutic contraindications is unclear. METHODS: We identified patients with HF and left ventricular ejection fraction ≤45% seen between January 1, 2010, and July 1, 2010, at a tertiary care Veterans Affairs Medical Center. Medical records were abstracted to evaluate utilization of and contraindications to β-blocker, angiotensin-converting enzyme inhibitor, aldosterone antagonist, anticoagulation for atrial fibrillation, implantable cardioverter-defibrillator, and cardiac resynchronization therapies. RESULTS: Of the 178 patients with HF and an ejection fraction ≤45%, 78 (44%) received every guideline-recommended therapy. After accounting for medical contraindications, 77 (72%) of 107 patients received every guideline-recommended therapy. Adherence to recommendations for β-blocker (98%), angiotensin-converting enzyme inhibitor/angiotensin blocker (95%), and anticoagulation (97%) were better than adherence to implantable cardioverter-defibrillator (82%), cardiac resynchronization therapy (59%), or aldosterone antagonist (51%) recommendations. In adjusted analysis, lower New York Heart Association functional class and care by a cardiologist were associated with improved guideline adherence (P < .001). CONCLUSIONS: Many patients with HF have therapeutic contraindications, and a failure to account for these may lead to a large underestimation of the true guideline adherence rates.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

November 2012

Volume

164

Issue

5

Start / End Page

750 / 755.e1

Location

United States

Related Subject Headings

  • Severity of Illness Index
  • Mineralocorticoid Receptor Antagonists
  • Middle Aged
  • Male
  • Humans
  • Heart Failure
  • Guideline Adherence
  • Female
  • Defibrillators, Implantable
  • Contraindications
 

Citation

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Chicago
ICMJE
MLA
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Atwater, B. D., Dai, D., Allen-Lapointe, N. M., Al-Khatib, S. M., Zimmer, L. O., Sanders, G. D., & Peterson, E. D. (2012). Is heart failure guideline adherence being underestimated? The impact of therapeutic contraindications. Am Heart J, 164(5), 750-755.e1. https://doi.org/10.1016/j.ahj.2012.08.002
Atwater, Brett D., David Dai, Nancy M. Allen-Lapointe, Sana M. Al-Khatib, Louise O. Zimmer, Gillian D. Sanders, and Eric D. Peterson. “Is heart failure guideline adherence being underestimated? The impact of therapeutic contraindications.Am Heart J 164, no. 5 (November 2012): 750-755.e1. https://doi.org/10.1016/j.ahj.2012.08.002.
Atwater BD, Dai D, Allen-Lapointe NM, Al-Khatib SM, Zimmer LO, Sanders GD, et al. Is heart failure guideline adherence being underestimated? The impact of therapeutic contraindications. Am Heart J. 2012 Nov;164(5):750-755.e1.
Atwater, Brett D., et al. “Is heart failure guideline adherence being underestimated? The impact of therapeutic contraindications.Am Heart J, vol. 164, no. 5, Nov. 2012, pp. 750-755.e1. Pubmed, doi:10.1016/j.ahj.2012.08.002.
Atwater BD, Dai D, Allen-Lapointe NM, Al-Khatib SM, Zimmer LO, Sanders GD, Peterson ED. Is heart failure guideline adherence being underestimated? The impact of therapeutic contraindications. Am Heart J. 2012 Nov;164(5):750-755.e1.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

November 2012

Volume

164

Issue

5

Start / End Page

750 / 755.e1

Location

United States

Related Subject Headings

  • Severity of Illness Index
  • Mineralocorticoid Receptor Antagonists
  • Middle Aged
  • Male
  • Humans
  • Heart Failure
  • Guideline Adherence
  • Female
  • Defibrillators, Implantable
  • Contraindications