title: Critical evaluation of the optimal medical therapy in the cardiac resynchronization therapy candidates--single centre experience.
abstract: The aim of the present study was to evaluate the optimal medical therapy in the chronic heart failure (CHF) patients referred from the comunity centres and the outpatients cardiology clinics for the cardiac resynchronization therapy with defibrilator (CRTD) to the Department of Cardiology, Na Homolce Hospital with the device implantation between 1st January 2008 and 30st September 2009.
  
  
  METHODS
  The optimal medical therapy was analysed retrospectively from the medical records of 179 consecutive CHF patients NYHA class III-IV. Beta-blockers (BB) were used only in 81% subjects referred for CRTD, ACE inhibitors (ACEI) were used only in 68% patients Angiotensin receptor blockers (ARB) were used in 18% subjects. ACEI or ARB were used in 81%, spironolacton was use in 59%. Recommended target DD for BB (carvedilol 25 mg bid) was used only in 13% subjects, recommended target DD for ACEI (enalapril 10 mg bid) was used only in 9.4% patients.
  
  
  RESULTS
  In the Department of Cardiology, the optimal medical therapy was changed after CRTD, BB were used in 95% subjects at discharge (p < 0.01) and the number of patients reaching at least of 50% of recommended daily dose (DD) of BB increased (p < 0.05). ACEI were recommended after CRTD in 80% subjects after implantation (p < 0.05), the number of patients reaching at least of 50% of recommended DD for ACEIs increased too (p < 0.05). There was no significant difference in ARB use recomended in the hospital (19% after CRTD - NS). ACEI or ARB were used in 98% patients after the device implanted (p < 0.05) and spironolacton in 77% after CRTD (p < 0.05).
  
  
  CONCLUSIONS
  Despite optimal composition of the optimal medical heart failure therapy only small number of CRTD candidates are reaching recommended drug dose. The optimization of the medical therapy in the specialized center lead to significantly higher proportion of CHF using the optimal therapy with the increased dose of BB and ACEI.
authors.affiliation: Department of Cardiology, Cardiovascular Centre, Na Homolce Hospital, Prague.
authors.forename: D
authors.initials: D
authors.lastname: Vondráková
authors.forename: F
authors.initials: F
authors.lastname: Málek
authors.forename: J
authors.initials: J
authors.lastname: Dvorák
authors.forename: L
authors.initials: L
authors.lastname: Sedivá
authors.forename: J
authors.initials: J
authors.lastname: Kupec
authors.forename: J
authors.initials: J
authors.lastname: Petrů
authors.forename: M
authors.initials: M
authors.lastname: Táborský
authors.forename: P
authors.initials: P
authors.lastname: Neuzil
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000008:administration & dosage; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage; D002227:Carbazoles / Q000008:administration & dosage; D058406:Cardiac Resynchronization Therapy; D000077261:Carvedilol; D017147:Defibrillators, Implantable; D004656:Enalapril / Q000008:administration & dosage; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000628:therapy; D006801:Humans; D019808:Losartan / Q000008:administration & dosage; D008297:Male; D011412:Propanolamines / Q000008:administration & dosage
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D004656:Enalapril; D019808:Losartan