title: Chronic Heart Failure Clinical Practice Guidelines' Class 1-A Pharmacologic Recommendations: Start-to-End Synergistic Drug Therapy?
abstract: BACKGROUND
  Chronic heart failure (HF) disease as an emerging epidemic has a high economic-psycho-social burden, hospitalization, readmission, morbidity and mortality rates despite many clinical practice guidelines' evidenced-based and consensus driven recommendations that include trials' initial-baseline data.
  
  
  OBJECTIVE
  To show that the survival and hospitalization-free event rates in the reviewed chronic HF clinical practice guidelines' class I-A recommendations as initial HF drug therapy (IDT) is possibly a combination and 'start-to-end' synergistic effect of the add-on ('end') HF drug therapy (ADT) to the baseline ('start') HF drug therapy (BDT).
  
  
  METHODS
  The references cited in the chronic HF clinical practice guidelines of the 2005, 2009, and 2013 American Heart Association/American College of Cardiology (AHA/ACC), the 2006 Heart Failure Society of America (HFSA), and the 2005, 2008, and 2012 European Society of Cardiology (ESC) were reviewed and compared with the respective guidelines' and other countries' recommendations.
  
  
  RESULTS
  The BDT using glycosides and diuretics is 79%-100% in the cited HF trials. The survival rates attributed to the BDT ('start') is 46%-89% and IDT ('end') 61%-92.8%, respectively. The hospitalization-free event rate of the BDT group: 47.1% to 85.3% and IDT group 61.8%-90%, respectively. Thus, the survival and hospitalization-free event rates of the ADT is 0.4%-15% and 4.6% to 14.7%, respectively. The extrapolated BDT survival is 8%-51% based on a 38% estimated natural HF survival rate for the time period109.
  
  
  CONCLUSIONS
  The contribution of baseline HF drug therapy (BDT) is relevant in terms of survival and hospitalization-free event rates compared to the HF class 1-A guidelines initial drug therapy recommendations (IDT). Further, the proposed initial HF drug ('end') therapy (IDT) has possible synergistic effects with the baseline HF drug ('start') therapy (BDT) and is essentially the add on HF drug therapy (ADT) in our analysis. The polypharmacy HF treatment is a synergistic effect due to BDT and ADT.
authors.affiliation: Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines.
authors.forename: Ramon F
authors.initials: RF
authors.lastname: Abarquez
authors.affiliation: Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines.
authors.forename: Paul Ferdinand M
authors.initials: PF
authors.lastname: Reganit
authors.affiliation: Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines.
authors.forename: Carmen N
authors.initials: CN
authors.lastname: Chungunco
authors.affiliation: Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines.
authors.forename: Jean
authors.initials: J
authors.lastname: Alcover
authors.affiliation: Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines.
authors.forename: Felix Eduardo R
authors.initials: FE
authors.lastname: Punzalan
authors.affiliation: Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines.
authors.forename: Eugenio B
authors.initials: EB
authors.lastname: Reyes
authors.affiliation: Section of Cardiology, Department of Medicine, University of the Philippines, College of Medicine and Philippine General Hospital, 6/F, PGH Compound, Taft Avenue, 1000 Manila, Philippines.
authors.forename: Elleen L
authors.initials: EL
authors.lastname: Cunanan
keywords: Heart failure; analysis; clinical practice guidelines