Optimization of heart FailUre medical Treatment after hospital discharge according to left ventricUlaR Ejection fraction: The FUTURE survey

Summary Background No clinical practice guidelines are available for the treatment of heart failure (HF) in patients with preserved left ventricular ejection fraction (LVEF). Aims To determine how cardiologists manage medical treatment in HF patients after hospital discharge, according to LVEF. Meth...

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Bibliographic Details
Published in:Archives of cardiovascular diseases 2012-06, Vol.105 (6), p.355-365
Main Authors: Cohen Solal, Alain, Leurs, Irina, Assyag, Patrick, Beauvais, Florence, Clerson, Pierre, Contre, Christine, Thebaut, Jean-François, Genoun, Maxime
Format: Article
Language:English
Subjects:
ACE inhibitors
Adrenergic beta-Antagonists - therapeutic use
Aged
Aged, 80 and over
Angiotensin II Type 1 Receptor Blockers - therapeutic use
Angiotensin-Converting Enzyme Inhibitors - therapeutic use
Atherosclerosis (general aspects, experimental research)
Beta-blockers
Biological and medical sciences
Blood and lymphatic vessels
Bêtabloquants
Cardiology. Vascular system
Cardiovascular
Cardiovascular Agents - therapeutic use
Cardiovascular system
Chi-Square Distribution
Cross-Sectional Studies
Diuretics - therapeutic use
Drug Substitution
Drug Utilization - statistics & numerical data
Ejection fraction
Epidemiology
Female
Fraction d’éjection
France - epidemiology
Guideline Adherence - statistics & numerical data
Health Care Surveys
Heart
Heart failure
Heart Failure - diagnosis
Heart Failure - drug therapy
Heart Failure - epidemiology
Heart Failure - physiopathology
Heart failure, cardiogenic pulmonary edema, cardiac enlargement
Humans
IEC
Insuffisance cardiaque
Internal Medicine
Investigative techniques of hemodynamics
Investigative techniques, diagnostic techniques (general aspects)
Logistic Models
Male
Medical sciences
Middle Aged
Mineralocorticoid Receptor Antagonists - therapeutic use
Patient Discharge - statistics & numerical data
Practice Guidelines as Topic
Practice Patterns, Physicians' - statistics & numerical data
Predictive Value of Tests
Prevalence
Private Sector
Referral and Consultation - statistics & numerical data
Retrospective Studies
Stroke Volume - drug effects
Time Factors
Treatment Outcome
Ventricular Dysfunction, Left - diagnosis
Ventricular Dysfunction, Left - drug therapy
Ventricular Dysfunction, Left - epidemiology
Ventricular Dysfunction, Left - physiopathology
Ventricular Function, Left - drug effects
Épidémiologie
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Summary:Summary Background No clinical practice guidelines are available for the treatment of heart failure (HF) in patients with preserved left ventricular ejection fraction (LVEF). Aims To determine how cardiologists manage medical treatment in HF patients after hospital discharge, according to LVEF. Methods The FUTURE study was a cross-sectional survey conducted in HF outpatients by French private cardiologists between September 2007 and August 2008. Patients had to have been hospitalized within the previous 18 months with a diagnosis of HF. Clinical data and HF treatments (angiotensin-converting enzyme inhibitors [ACEIs], angiotensin receptor blockers [ARBs], beta-blockers, diuretics and aldosterone antagonists) were recorded retrospectively, with precise information on drug doses, at two successive time points (at hospital discharge and at the index consultation). HF treatment was compared in patients with reduced (less than or equal to 40%) versus preserved (more than 40%) LVEF. Results Completed data were available for 1137 HF patients enrolled by 424 cardiologists. Mean patient age was 72 ± 11 years; LVEF was reduced in 56% and preserved in 44%. The therapeutic approach was similar in the two groups, both at hospital discharge and at the index consultation. At the index consultation, HF treatment was: beta-blocker (74%); ACEI/ARB (83%); loop diuretic (86%); aldosterone antagonist (31%). The majority of patients (62%) received a beta-blocker plus an ACEI or an ARB; 56% reached more than or equal to 50% of the target dose for each treatment. There were no major differences in treatments and dosages between the groups with low and preserved LVEF. In 15% of cases where the drug dose was not increased, fear of adverse events was reported as the reason. Conclusion The FUTURE survey showed a similar approach to HF treatment irrespective of LVEF. Compared with previous studies, we saw an improvement in the use of recommended HF drugs, especially beta-blockers. However, achievement of target doses could be improved.
ISSN:1875-2136
1875-2128
DOI:10.1016/j.acvd.2012.04.003