Is the gap between guidelines and clinical practice in heart failure treatment being filled? Insights from the IMPACT RECO survey.
BACKGROUND
Recent registries have shown that recommended drugs for the treatment of chronic heart failure (CHF) are under-prescribed in daily practice.


OBJECTIVE
To determine prescription rates of CHF drugs, and to assess predictive factors for drug prescription using data from a large panel of French cardiologists.


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.
de Groote
P
P
Service de Cardiologie C, Hôpital Cardiologique, CHRU, Bd du Pr Jules Leclercq, 59037, Lille Cedex, France. pdegroote@chru-lille.fr
Isnard
R
R
Assyag
P
P
Clerson
P
P
Ducardonnet
A
A
Galinier
M
M
Jondeau
G
G
Leurs
I
I
Thébaut
J-F
JF
Komajda
M
M
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D054796:Drug Dosage Calculations; D011307:Drug Prescriptions / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005602:France; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists