ORLANDO, FLA. — Starting heart failure patients on a β-blocker and ACE inhibitor before hospital discharge sharply increases the likelihood that they will be on these key medications at follow-up 60-90 days later, Gregg C. Fonarow, M.D., reported at the annual meeting of the American College of Cardiology.
“What this really tells us is that hospitalization can serve as a teachable moment for patients and clinicians regarding heart failure medications, that patients can be effectively initiated on these evidence-based therapies, and if they're started in the hospital they're much more likely to be on treatment during long-term follow-up,” he said.
“We need to provide for all patients hospitalized with heart failure a systematic approach to ensure that the evidence-based therapies are started prior to discharge,” said Dr. Fonarow, professor of cardiovascular medicine at the University of California, Los Angeles, and director of the Ahmanson-UCLA Cardiomyopathy Center.
He presented data on 4,434 patients with systolic heart failure (HF) treated at 86 hospitals participating in the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF) registry, a national quality-improvement project.
None of the patients in this subset of the larger OPTIMIZE-HF database had contraindications to β-blockers or ACE inhibitors/angiotensin receptor blockers (ARBs). Of the 86% discharged on a β-blocker, 95% remained on β-blocker therapy at follow-up 60-90 days post discharge. In contrast, only 32% of patients who were not yet on a β-blocker at discharge were taking one at follow-up.
“That means two-thirds of these eligible patients [discharged without β blocker] remained untreated with what is our single most important life-saving therapy in heart failure: β-blocker treatment,” said Dr. Fonarow, director of OPTIMIZE-HF.
The same was true for ACE inhibitors/ARBs: 84% of eligible patients were on one of these drugs at discharge, and 74% of this group remained on the medication at 60-90 days. Only 19% of patients not discharged on one of these drugs were taking one at follow-up.
“Many clinicians have kind of had the view, 'Well, we don't need to worry about starting treatment in the hospital, we'll get around to it on an outpatient basis.' There hasn't necessarily been a consensus that each of these therapies needs to be started prior to hospital discharge,” Dr. Fonarow observed.
But that's changing fast, in large part because of the evidence gathered in OPTIMIZE-HF. At the ACC meeting, the American Heart Association launched a new nationwide, hospital-based, quality-improvement project called Get With The Guidelines-Heart Failure (GWTG-HF).
The program, aimed at accelerating adherence to ACC/AHA treatment guidelines, utilizes techniques similar to those employed in the OPTIMIZE—HF registry, including decision-support tools, customized patient education materials, real-time performance benchmarking, and collaborative workshops to help hospitals share best practices. Dr. Fonarow is chairman of the GWTG Science Subcommittee.
“We hope that hospitals across the country will sign up and participate. Already in place for more than 2 years has been a program called Get With The Guidelines- Coronary Artery Disease that has shown remarkable improvements in care and is currently in more than 300 U.S. hospitals,” he said.
With 5 million Americans currently diagnosed with HF, and the ranks expected to swell further as baby boomers age, this type of systems approach is badly needed, according to John S. Rumsfeld, M.D., who chaired a session on quality-improvement programs at the ACC meeting.
“The U.S. over the next 20-30 years is going to be overwhelmed by the need for heart failure care. If we don't do this now, just think of the potential number of people who won't get these treatments. We can have all sorts of late-breaking clinical trials telling us about better care, but if we don't apply them, we won't actually be improving our population outcomes,” noted Dr. Rumsfeld of the University of Colorado, Denver.
GWTG-HF and OPTIMIZE-HF are both funded by GlaxoSmithKline Inc. Dr. Fonarow is a consultant to and member of the speakers' bureau for the pharmaceutical company.