Why Aren't More Physicians Following Treatment Guidelines for CHF?

Despite extensive clinical evidence that drugs such as ACE-inhibitors, angiotensin receptor blockers (ARBs), and beta blockers are highly effective in treating congestive heart failure (CHF), a study has found that physicians are not using the medications as recommended in heart-failure treatment guidelines developed by the American Heart Association and the American College of Cardiology.

A news release from Stanford University Medical Center, citing study results from the article “Lack of Improvement in Outpatient Management of Congestive Heart Failure in the United States,” published in the Archives of Internal Medicine, says that “the use of two types of drug therapy for treating heart failure has steadily declined since the early and mid-2000s, and that the medications are being prescribed to only about one-third of the patients who would benefit from them.” The study was based on data from a national physician survey to determine which medications were being prescribed to treat heart-failure patients from 1994 through 2009.

According to senior author Randall Stafford, MD, PhD, associate professor of medicine at the Stanford Prevention Research Center, “Tried-and-true therapies are not getting the attention they really deserve… These therapies are of great value to the vast majority of heart-failure patients, and to see them being used in less than 40 percent of patients is a concern."

In the Archives of Internal Medicine article, Stafford and Dipanjan Banerjee, MD, a clinical instructor in cardiovascular medicine at Stanford, reported that use of ACE-inhibitors and ARBs increased from 34% in 1994 to 45% in 2002, but then decreased to 32% by 2009. They also found that the use of the ACE-inhibitors and ARBs increased from 34% in 1994 to 45% in 2002, but dropped down to 32% by 2009.

Although Stafford said that he’s not sure what the reason for the decline is, one possible explanation may be that the relative dearth of new studies on the use of these medications in congestive heart failure may have “lowered the treatments' profile among physicians and patients.”