The effect of neurohormonal antagonists in reducing heart failure hospitalizations.
OBJECTIVE
Heart failure (HF) is a major health problem facing the US and studies suggest that the incidence of this condition will rise significantly over the next 10 years. Limiting the incidence or duration of HF hospitalizations would, therefore, have a major impact on healthcare costs. The purpose of this review is to establish and discuss the proposed neurohormonal mechanisms by which HF can occur along with pharmacologic treatments designed to antagonize these pathological states in order to aid in the reduction of HF hospitalization.


METHODS
A Medline search (to December 200) was performed to compile published literature and assess numerous large-scale studies regarding the use of neurohormonal antagonists in the treatment of HF. In addition, evaluation of statistics and figures from various organizations dedicated to the improvement of HF care was utilized as aids in understanding the impact of these therapies on hospitalization and healthcare.


RESULTS
Heart failure is the most costly cardiovascular disease in the United States, with an estimated annual expenditure in excess of $20 billion. The frequency and duration of HF-associated hospitalizations are the key contributors to this pronounced economic burden. Use of pharmacologic interventions designed to specifically antagonize the renin-angiotensin-aldosterone system and the adrenergic system has had a significant impact on limiting hospitalization with regard to HF. However, the ever burdensome level of re-hospitalization rates for these patients is still problematic and appears to be based on a disconnect between established procedures to effectively treat these patients and the inability to accurately measure performance standards by managed care organization and hospital accreditation bodies. As a consequence, these antagonists, beta-blockers in particular, are still underutilized in the treatment of HF. Studies have shown that many of these hospitalizations could have been avoided had healthcare providers followed effective HF management programs.


CONCLUSIONS
Current evidence supports the benefits of neurohormonal blockade in decreasing hospital admissions due to HF. Appropriate use of these agents plus agreed-upon guidelines for treatment can continue to significantly decrease total HF-related hospitalizations and costs. Inclusion of beta-blockers as a performance measure in quality-of-care HF indicators should be considered as an important instrument to increase their utilization and to improve overall HF care.
Williams
Randall E
RE
Evanston Northwestern Healthcare, Northwestern University, Chicago, IL 60194, USA. rwilliams@northwestern.edu
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002303:Cardiac Output, Low / Q000517:prevention & control*; D006760:Hospitalization; D006801:Humans; D018377:Neurotransmitter Agents / Q000037:antagonists & inhibitors*; D012084:Renin-Angiotensin System / Q000187:drug effects*
D000319:Adrenergic beta-Antagonists; D018377:Neurotransmitter Agents