Author + information
- Received February 12, 2018
- Revision received April 21, 2018
- Accepted April 23, 2018
- Published online July 16, 2018.
- Stephen J. Greene, MDa,b,
- Javed Butler, MD, MPH, MBAc,
- Nancy M. Albert, PhDd,
- Adam D. DeVore, MD, MHSa,b,
- Puza P. Sharma, MBBS, MPH, PhDe,
- Carol I. Duffy, DOe,
- C. Larry Hill, PhDa,
- Kevin McCague, MAe,
- Xiaojuan Mi, PhDa,
- J. Herbert Patterson, PharmDf,
- John A. Spertus, MD, MPHg,
- Laine Thomas, PhDa,
- Fredonia B. Williams, EdDh,
- Adrian F. Hernandez, MD, MHSa,b and
- Gregg C. Fonarow, MDi,∗ (, )@UCLAHealth@gcfmd@SJGreene_md@JavedButler1@texhern@DCRINews
- aDuke Clinical Research Institute, Durham, North Carolina
- bDivision of Cardiology, Duke University School of Medicine, Durham, North Carolina
- cDepartment of Medicine, University of Mississippi, Jackson, Mississippi
- dCleveland Clinic Foundation, Cleveland, Ohio
- eNovartis Pharmaceuticals Corporation, East Hanover, New Jersey
- fEshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina
- gSaint Luke’s Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri
- hMended Hearts, Huntsville, Alabama
- iAhmanson-UCLA Cardiomyopathy Center, University of California-Los Angeles, Los Angeles, California
- ↵∗Address for correspondence:
Dr. Gregg C. Fonarow, Ahmanson-UCLA Cardiomyopathy Center, University of California Los Angeles, 10833 LeConte Ave, Room 47-123 CHS, Los Angeles, California 90095.
Background Guidelines strongly recommend patients with heart failure with reduced ejection fraction (HFrEF) be treated with multiple medications proven to improve clinical outcomes, as tolerated. The degree to which gaps in medication use and dosing persist in contemporary outpatient practice is unclear.
Objectives This study sought to characterize patterns and factors associated with use and dose of HFrEF medications in current practice.
Methods The CHAMP-HF (Change the Management of Patients with Heart Failure) registry included outpatients in the United States with chronic HFrEF receiving at least 1 oral medication for management of HF. Patients were characterized by baseline use and dose of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB), angiotensin receptor neprilysin inhibitor (ARNI), beta-blocker, and mineralocorticoid receptor antagonist (MRA). Patient-level factors associated with medication use were examined.
Results Overall, 3,518 patients from 150 primary care and cardiology practices were included. Mean age was 66 ± 13 years, 29% were female, and mean EF was 29 ± 8%. Among eligible patients, 27%, 33%, and 67% were not prescribed ACEI/ARB/ARNI, beta-blocker, and MRA therapy, respectively. When medications were prescribed, few patients were receiving target doses of ACEI/ARB (17%), ARNI (14%), and beta-blocker (28%), whereas most patients were receiving target doses of MRA therapy (77%). Among patients eligible for all classes of medication, 1% were simultaneously receiving target doses of ACE/ARB/ARNI, beta-blocker, and MRA. In adjusted models, older age, lower blood pressure, more severe functional class, renal insufficiency, and recent HF hospitalization generally favored lower medication utilization or dose. Social and economic characteristics were not independently associated with medication use or dose.
Conclusions In this contemporary outpatient HFrEF registry, significant gaps in use and dose of guideline-directed medical therapy remain. Multiple clinical factors were associated with medication use and dose prescribed. Strategies to improve guideline-directed use of HFrEF medications remain urgently needed, and these findings may inform targeted approaches to optimize outpatient medical therapy.
CHAMP-HF was supported by Novartis Pharmaceuticals. Dr. Greene has received support from U.S. National Institutes of Health (NIH) grant 5T32HL069749-14, Heart Failure Society of America/Emergency Medicine Foundation Acute Heart Failure Young Investigator Award funded by Novartis, and from Novartis. Dr. Butler has received research support from the National Institutes of Health, Patient-Centered Outcomes Research Institute, and European Union; and has consulted for Amgen, Array, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squib, CVRx, G3 Pharmaceutical, Innolife, Janssen, Luitpold, Medtronic, Merck, Novartis, Relypsa, StealthPeptide, SC Pharma, Vifor, and ZS Pharma. Dr. DeVore has received funding from the American Heart Association, Amgen, National Institutes of Health, and Novartis; and has consulted for Novartis. Dr. Albert has consulted for Novartis and Boston Scientific. Drs. Sharma and Duffy and Mr. McCague are employees of Novartis. Dr. Patterson has received research funding from Amgen, Bristol-Myers Squibb, Merck, Novartis, and Otsuka; and has consulted for Novartis. Dr. Spertus has consulted for Novartis; and holds copyright to the Kansas City Cardiomyopathy Questionnaire. Dr. Thomas has received funding from Duke University. Dr. Hernandez has consulted for AstraZeneca, Bayer, Boston Scientific, Merck, Novartis, and Sanofi; and has received support from AstraZeneca, GlaxoSmithKline, Luitpold, Merck, and Novartis. Dr. Fonarow has received funding from the National Institutes of Health; and has consulted for Amgen, Bayer, Medtronic, and Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 12, 2018.
- Revision received April 21, 2018.
- Accepted April 23, 2018.
- 2018 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.