European Heart Journal Advance Access originally published online on September 23, 2005
European Heart Journal 2005 26(24):2706-2713; doi:10.1093/eurheartj/ehi499
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Under-utilization of evidence-based drug treatment in patients with heart failure is only partially explained by dissimilarity to patients enrolled in landmark trials: a report from the Euro Heart Survey on Heart Failure
1Department of Cardiology, Erasmus MC, Room Ba561, PO Box 2040, 3000 CA Rotterdam, The Netherlands
2Department of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
3Göteborg University and Sahlgrenska University Hospital/Östra, Göteborg, Sweden
4Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
5Department of Cardiology, Hospital Clinico Virgen de la Victoria, Universidad de Malaga, Malaga, Spain
6Department of Cardiology, Castle Hill Hospital, Kingston upon Hull, UK
Received 7 April 2005; revised 16 August 2005; accepted 25 August 2005; online publish-ahead-of-print 23 September 2005.
* Corresponding author. Tel: +31 10 4632891. E-mail address: m.lenzen{at}erasmusmc.nl
See page 2611 for the editorial comment on this article (doi:10.1093/eurheartj/ehi597)
Aims Surveys on heart failure management suggest under-utilization of life-saving evidence-based treatment. Evidence-based medicine and clinical guidelines are based on the results of randomized controlled trials. Therefore, we investigated how patients who fulfilled the enrolment criteria of randomized trials were treated in real life.
Methods and results We selected three large placebo-controlled trials of patients with chronic heart failure, in which ACE-inhibitors (ACE-Is), ß-blockers, and spironolactone proved to be safe and effective. The major enrolment criteria of trials were identified and applied to patients enrolled in the Euro Heart Survey on Heart Failure to identify the proportion of patients eligible for treatment and also treated appropriately. Of the 10 701 patients who were enrolled in the Euro Heart Survey on Heart Failure, only a small percentage (13%) would have qualified for participation in at least one of the selected trials. Patients who fulfilled enrolment criteria of the identified trials were more likely to be treated with ACE-Is (83% of SOLVD-eligible patients), ß-blockers (54% of MERIT-HF-eligible patients), and aldosterone antagonists (43% of RALES-eligible patients) than trial-ineligible patients. Almost half of SOLVD-eligible patients who were treated with ACE-Is received the target dose as recommended in the guidelines, but only <10% of MERIT-HF eligible patients who were treated with ß-blockers received the target dose.
Conclusion ACE-Is are widely utilized but given in lower doses than proven effective in clinical trials. ß-Blockers are underused and given in lower doses to patients who fulfil the enrolment criteria of relevant landmark trials.
Key Words: Heart failure • Randomized clinical trials • Treatment • Under-utilization
CiteULike 
Connotea 
Del.icio.us What's this?
Related articles in EHJ:
- Managing patients with heart failure: the reality of clinical practice
- Iain Squire
EHJ 2005 26: 2611-2613.[Extract] [FREE Full Text]
This article has been cited by other articles:
|
|
 |
|
  K. Swedberg, M. Komajda, M. Bohm, J. S. Borer, I. Ford, and L. Tavazzi Rationale and design of a randomized, double-blind, placebo-controlled outcome trial of ivabradine in chronic heart failure: the Systolic Heart Failure Treatment with the If Inhibitor Ivabradine Trial (SHIFT) Eur J Heart Fail, November 5, 2009; (2009) hfp154v1. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Cohen-Solal, D. Kotecha, D. J van Veldhuisen, D. Babalis, M. Bohm, A. J. Coats, M. Roughton, P. Poole-Wilson, L. Tavazzi, M. Flather, et al. Efficacy and safety of nebivolol in elderly heart failure patients with impaired renal function: insights from the SENIORS trial Eur J Heart Fail, September 1, 2009; 11(9): 872 - 880. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Krum Consider {beta} blockers for patients with heart failure BMJ, June 1, 2009; 338(jun01_2): b1728 - b1728. [Full Text]
|
|
|
|
|
|
M. Baumhakel, U. Muller, and M. Bohm Influence of gender of physicians and patients on guideline-recommended treatment of chronic heart failure in a cross-sectional study Eur J Heart Fail, March 1, 2009; 11(3): 299 - 303. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. de Groote, R. Isnard, P. Clerson, G. Jondeau, M. Galinier, P. Assyag, N. Demil, A. Ducardonnet, J.-F. Thebaut, and M. Komajda Improvement in the management of chronic heart failure since the publication of the updated guidelines of the European Society of Cardiology: The Impact-Reco Programme Eur J Heart Fail, January 1, 2009; 11(1): 85 - 91. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Hoeks and D. Poldermans CHAPTER 34 Non-cardiac Surgery in Cardiac Patients ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Erhardt, M. Komajda, F.D. R. Hobbs, and J. Soler-Soler Cardiologists' awareness and perceptions of guidelines for chronic heart failure. The ADDress your Heart survey Eur J Heart Fail, October 1, 2008; 10(10): 1020 - 1025. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Macchia, S. Monte, F. Pellegrini, M. Romero, A. D'Ettorre, L. Tavazzi, G. Tognoni, and A. P. Maggioni Depression worsens outcomes in elderly patients with heart failure: An analysis of 48,117 patients in a community setting Eur J Heart Fail, July 1, 2008; 10(7): 714 - 721. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Azevedo Gender differences in heart failure Heart, March 1, 2008; 94(3): 264 - 265. [Full Text] [PDF]
|
|
|
|
|
|
M J Lenzen, A Rosengren, W J M S. op Reimer, F Follath, E Boersma, M L Simoons, J G F Cleland, and M Komajda Management of patients with heart failure in clinical practice: differences between men and women Heart, March 1, 2008; 94(3): e10 - e10. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. de Groote, R. Isnard, P. Assyag, P. Clerson, A. Ducardonnet, M. Galinier, G. Jondeau, I. Leurs, J.-F. Thebaut, and M. Komajda Is the gap between guidelines and clinical practice in heart failure treatment being filled? Insights from the IMPACT RECO survey Eur J Heart Fail, December 1, 2007; 9(12): 1205 - 1211. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Gustafsson, M. Schou, L. Videbaek, T. Nielsen, H. Ulriksen, J. Markenvard, T. L. Svendsen, H. Ryde, E. Vigholt, P. Hildebrandt, et al. Treatment with beta-blockers in nurse-led heart failure clinics: Titration efficacy and predictors of failure Eur J Heart Fail, September 1, 2007; 9(9): 910 - 916. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Dobre, D. J. van Veldhuisen, M. J.L. DeJongste, C. Lucas, G. Cleuren, R. Sanderman, A. V. Ranchor, and F. M. Haaijer-Ruskamp Prescription of beta-blockers in patients with advanced heart failure and preserved left ventricular ejection fraction. Clinical implications and survival Eur J Heart Fail, March 1, 2007; 9(3): 280 - 286. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Siirila-Waris, J. Lassus, J. Melin, K. Peuhkurinen, M. S. Nieminen, V.-P. Harjola, and for the FINN-AKVA study group Characteristics, outcomes, and predictors of 1-year mortality in patients hospitalized for acute heart failure Eur. Heart J., December 2, 2006; 27(24): 3011 - 3017. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Nieminen, D. Brutsaert, K. Dickstein, H. Drexler, F. Follath, V.-P. Harjola, M. Hochadel, M. Komajda, J. Lassus, J. L. Lopez-Sendon, et al. EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population Eur. Heart J., November 2, 2006; 27(22): 2725 - 2736. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Squire Managing patients with heart failure: the reality of clinical practice Eur. Heart J., December 2, 2005; 26(24): 2611 - 2613. [Full Text] [PDF]
|
|