Around 5.7 million people in the United States have heart failure; it contributes to more than 300,000 deaths each year in the United States. A recent study from the University of California Los Angeles (UCLA) Health Sciences department, published in the Journal of the American College of Cardiology, found that many individuals with heart failure do not receive the recommended medications and when prescribed it is frequently at lower doses than recommended.
Heart failure occurs when the heart muscles do not pump blood as well as it should be, it can’t keep up with the usual workload. Delivery of oxygen and nutrient-rich blood to the body’s cells is dependent on a properly pumping heart but when this is impeded normal body function becomes interrupted. Symptoms of heart failure can include shortness of breath, fatigue, irregular heartbeat, persistent cough, rapid weight gain, lack of appetite, and chest pain if caused by a heart attack. Heart failure often occurs after the heart is damaged or weakened by other conditions such as heart attack, high blood pressure, faulty heart valves, heart defects, and heart arrhythmias. Other risk factors that contribute to heart failure are diabetes, sleep apnea, viruses, alcohol and tobacco use, obesity, and use of certain medications. Treatment options for heart failure include lifestyle changes, surgical procedures and devices, and medications.
Clinical trials of various medication have been completed and proven to help people with heart failure live longer and feel better. However, a study between 2007 and 2009 showed that many patients did not receive the recommended dose of these medications. The study led by senior author Dr. Gregg Fonarow at UCLA sought to determine if prescribing practices improved after the previous survey. The study included 3,518 patients from over 150 primary care and cardiology practices enrolled in the Change the Management of Patients with Heart Failure Registry (CHAMP-HF), this study looked at adult outpatients who were diagnosed with heart failure and reduced ejection fraction (measurement of the percentage of blood leaving the heart each time it contracts).
Looking at three categories of heart failure medication, between 27% and 67% of patients were not prescribed the recommended drugs. Patients that did receive medication were generally receiving lower-doses than recommended. Of all three categories of medication, less than 25% of patients received all three simultaneously, and only 1% received the correct dose of all three types. Of the patients, those who were elderly, experiencing kidney disease, had worsening symptoms or were recently hospitalized for heart failure frequently were prescribed medications at doses lower than recommended compared to other patients. Further studies will seek to determine why these groups were more likely to be prescribed lower doses than others.
Overall, these results suggest that prescribing and dosing of heart failure medications has failed to improve over the past decade despite the previous study. New strategies are needed to ensure that proper prescribing and dosing of heart failure medication occurs; this will improve the care and outcomes for individuals with heart failure.
To learn more about heart failure, watch the video below!
Mayo Clinic, American Heart Association
