Full use of evidence-based therapies for heart failure could save nearly 70,000 lives each year
Research Activities October 2011, No. 374
Many thousands of deaths from heart failure could be avoided each year with optimal use of evidence-based therapies, concludes a new study. All of these therapies: angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs), beta-adrenergic blocking agents (beta-blockers), aldosterone antagonists, hydralazine/isosorbide dinitrate (H/ID), implantable cardioverter defibrillators, and cardiac resynchronization therapy (CRT) have been found to be effective in treating heart failure, with the benefits outweighing the risks.
Despite active efforts to get physicians and hospitals to fully implement guidelines recommending the use of each of these therapies, many heart failure patients are not given treatments for which they are eligible.Yet many of these treatments are known to reduce the relative risk of death—from 17 percent for ACEI/ARB therapy to 43 percent for H/ID therapy. There are 2,644,800 patients with heart failure and low left ventricular ejection fraction (indicator of weak pumping power of the heart). Three of the guideline-endorsed therapies are used in more than 50 percent of such eligible patients and up to 86 percent for treatment with beta-blockers. Yet, the majority of eligible heart failure patients fail to get three of the treatments: aldosterone antagonists (64 percent untreated); H/ID (93 percent untreated); and CRT (61 percent untreated).
The researchers calculate that optimal use of the guideline-recommended heart failure therapies would save an additional 67,996 lives each year, including 21,407 from optimal use of aldosterone antagonists. Even optimal use of beta-blockers, which are already widely administered, could save another 12,922 lives annually.
The findings are based on data from the 2010 American Heart Association Heart Disease and Stroke Statistics Update and registries of patients with heart failure.
The study was funded in part by the Agency for Healthcare Research and Quality (HS16964) to the Duke University Center for Education and Research on Therapeutics (CERT). For more information on the CERTs program, visit Centers for Education & Research on Therapeutics (CERTs) .
More details are in "Potential impact of optimal implementation of evidence-based heart failure therapies on mortality" by Gregg C. Fonarow, M.D., Clyde W. Yancy, M.D., Adrian F. Hernandez, M.D., M.H.S., and others in the June 2011 American Heart Journal 161(6), pp. 1024-1030.e1-3.