title: Potential impact of optimal implementation of evidence-based heart failure therapies on mortality.
abstract: 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.
authors.affiliation: Ahmanson-UCLA Cardiomyopathy Center, Ronald Reagan-UCLA Medical Center, Los Angeles, CA 90095-1679, USA. gfonarow@mednet.ucla.edu
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Clyde W
authors.initials: CW
authors.lastname: Yancy
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
mesh_terms: D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006333:Heart Failure / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D017063:Outcome Assessment, Health Care; D017410:Practice Guidelines as Topic; D013318:Stroke Volume
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors