title: Gaps in Medical and Device Therapy for Patients with Left Ventricular Systolic Dysfunction: The EchoGap Study.
abstract: OBJECTIVE
  To assess gaps between guidelines and medicine prescription/dosing and referral for defibrillator therapy in patients with left ventricular systolic dysfunction (LVSD).
  
  
  METHODS
  Outpatient echocardiography reports at an academic hospital centre were screened and outpatients with LVEF<40% were included. A questionnaire was mailed to the patients' physician, querying prescription/dosing of ACE-inhibitors (ACEi), angiotensin receptor blockers (ARB) and beta-blockers (BB). Patients with LVEF<30% had additional questions on implantable cardiac defibrillator (ICD) referral.
  
  
  RESULTS
  Mean age was 69.6+/-12.2 years and mean LVEF was 29.7+/-6.5%. ACEi and/or ARB prescription rate was 260/309(84.1%) versus 256/308(83.1%) for BB (p=NS for comparison). Of patients on ACEi, 77/183(42.1%) were on target dose, compared to 7/45(15.5%) for ARB and 9/254(3.5%) for BB (p<0.01). Of 171/309 patients (55.3%) with LVEF<30%, 72/171(42.1%) had an ICD and 16/171(9.4%) were referred for one.
  
  
  CONCLUSIONS
  Prescription rates of evidence-based HF medicines are relatively high in outpatients with LVSD referred for echocardiography at this Canadian academic medical centre; however, the proportion of patients at target doses was modest for ACEi and low for ARB and BB. Approximately half of patients who qualify for ICD by EF alone have one or were referred. Important reasons for patients with LVSD not on evidence-based therapy were identified.
authors.affiliation: Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Hisham
authors.initials: H
authors.lastname: Dokainish
authors.affiliation: Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Lauren
authors.initials: L
authors.lastname: Jewett
authors.affiliation: Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Robby
authors.initials: R
authors.lastname: Nieuwlaat
authors.affiliation: Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Joshua
authors.initials: J
authors.lastname: Coulson
authors.affiliation: Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Demers
authors.affiliation: Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Eva
authors.initials: E
authors.lastname: Lonn
authors.affiliation: Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Jeff
authors.initials: J
authors.lastname: Healey
authors.affiliation: Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Brian
authors.initials: B
authors.lastname: Haynes
authors.affiliation: Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Stuart
authors.initials: S
authors.lastname: Connolly
keywords: Echocardiography; Evidence-based Medicine; Heart Failure; Knowledge Translation; Left Ventricular Dysfunction; Treatment Gaps.