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Potential impact of optimal implementation of evidence-based heart failure therapies on mortality.

Publication ,  Journal Article
Fonarow, GC; Yancy, CW; Hernandez, AF; Peterson, ED; Spertus, JA; Heidenreich, PA
Published in: Am Heart J
June 2011

BACKGROUND: Although multiple therapies have been shown to lower mortality in patients with heart failure (HF) and reduced left ventricular ejection fraction, their application in clinical practice has been less than ideal. To date, empiric estimation of the potential benefits that could be gained from eliminating these existing treatment gaps with optimal implementation has not been quantified. METHODS: Eligibility criteria for each evidence-based HF therapy, the estimated frequency of use/nonuse of specific treatments, the case fatality rates, and the risk reductions due to treatment were obtained from published sources. The numbers of deaths prevented or postponed because of each guideline-recommended therapy and overall were determined. RESULTS: Among patients with HF with reduced left ventricular ejection fraction in the United States (n = 2,644,800), the number eligible but not currently treated ranged from 139,749 for hydralazine/isorbide dinitrate to 852,512 for implantable cardioverter defibrillators. The comparative number of deaths that could potentially be prevented per year with optimal implementation of angiotensin-converting enzyme inhibitor/angiotensin receptor antagonist is 6,516; β-blockers, 12,922; aldosterone antagonists, 21,407; hydralazine/isorbide dinitrate, 6,655; cardiac resynchronization therapy, 8,317; and implantable cardioverter defibrillators, 12,179. If these treatment benefits were additive, optimal implementation of all 6 therapies could potentially prevent 67,996 deaths a year. CONCLUSIONS: A substantial number of HF deaths in this country could potentially be prevented by optimal implementation of evidence-based therapies. These data may underscore the importance of performance improvement efforts to translate evidence-based therapy to routine clinical practice so as to reduce contemporary HF mortality.

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Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

June 2011

Volume

161

Issue

6

Start / End Page

1024 / 30.e3

Location

United States

Related Subject Headings

  • Stroke Volume
  • Practice Guidelines as Topic
  • Outcome Assessment, Health Care
  • Humans
  • Heart Failure
  • Guideline Adherence
  • Evidence-Based Medicine
  • Cardiovascular System & Hematology
  • Angiotensin-Converting Enzyme Inhibitors
  • Angiotensin Receptor Antagonists
 

Citation

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Fonarow, G. C., Yancy, C. W., Hernandez, A. F., Peterson, E. D., Spertus, J. A., & Heidenreich, P. A. (2011). Potential impact of optimal implementation of evidence-based heart failure therapies on mortality. Am Heart J, 161(6), 1024-30.e3. https://doi.org/10.1016/j.ahj.2011.01.027
Fonarow, Gregg C., Clyde W. Yancy, Adrian F. Hernandez, Eric D. Peterson, John A. Spertus, and Paul A. Heidenreich. “Potential impact of optimal implementation of evidence-based heart failure therapies on mortality.Am Heart J 161, no. 6 (June 2011): 1024-30.e3. https://doi.org/10.1016/j.ahj.2011.01.027.
Fonarow GC, Yancy CW, Hernandez AF, Peterson ED, Spertus JA, Heidenreich PA. Potential impact of optimal implementation of evidence-based heart failure therapies on mortality. Am Heart J. 2011 Jun;161(6):1024-30.e3.
Fonarow, Gregg C., et al. “Potential impact of optimal implementation of evidence-based heart failure therapies on mortality.Am Heart J, vol. 161, no. 6, June 2011, pp. 1024-30.e3. Pubmed, doi:10.1016/j.ahj.2011.01.027.
Fonarow GC, Yancy CW, Hernandez AF, Peterson ED, Spertus JA, Heidenreich PA. Potential impact of optimal implementation of evidence-based heart failure therapies on mortality. Am Heart J. 2011 Jun;161(6):1024–30.e3.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

June 2011

Volume

161

Issue

6

Start / End Page

1024 / 30.e3

Location

United States

Related Subject Headings

  • Stroke Volume
  • Practice Guidelines as Topic
  • Outcome Assessment, Health Care
  • Humans
  • Heart Failure
  • Guideline Adherence
  • Evidence-Based Medicine
  • Cardiovascular System & Hematology
  • Angiotensin-Converting Enzyme Inhibitors
  • Angiotensin Receptor Antagonists