Influence of renal function on the use of guideline-recommended therapies for patients with heart failure.
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.
Heywood
J Thomas
JT
Scripps Clinic, La Jolla, CA, USA. Heywood.Tom@scrippshealth.org
Fonarow
Gregg C
GC
Yancy
Clyde W
CW
Albert
Nancy M
NM
Curtis
Anne B
AB
Stough
Wendy Gattis
WG
Gheorghiade
Mihai
M
McBride
Mark L
ML
Mehra
Mandeep R
MR
O'Connor
Christopher M
CM
Reynolds
Dwight
D
Walsh
Mary Norine
MN
D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003404:Creatinine / Q000097:blood*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate / Q000502:physiology*; D019983:Guideline Adherence; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010045:Outpatients; D017410:Practice Guidelines as Topic; D011379:Prognosis; D011446:Prospective Studies; D051437:Renal Insufficiency / Q000097:blood / Q000150:complications* / Q000503:physiopathology; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left
D002317:Cardiovascular Agents; D003404:Creatinine