High-risk Heart Patients Aren't Getting Proven Therapies

Findings from an American Heart Association (AHA) study indicate that patients who are at a higher risk or mortality from heart failure are also at a higher risk of not receiving evidence-based treatments for the condition. More high-risk patients have contraindications for receiving ACE inhibitors, angiotensin receptor blockers and beta-blockers, according to the research, which is published in Circulation: Cardiovascular Quality and Outcomes.

Despite the fact that “the absolute benefits of an interventionare proportional to patients’ underlying risk, studiesin heart failure have noted a paradoxical inverse relationshipbetween treatment and risk,” say researchers. With that in mind, representatives from various medical institutions set out to determine the extent to which this reflectshigher rates of contraindications in patients with higher risk,or larger gaps in care quality. A group of 18,307 patients with leftventricular systolic dysfunction from 194 hospitals participating in the AHA’s Get With The Guidelines (GWTG)—Heart Failure program were categorized according to their estimated risk for in-hospitalmortality using a validated risk score.

Researchers determined—across all levels of risk—the percentage of patientswith contraindications to ACE inhibitors or angiotensin receptor blockers and β-blockers, as well as patients without contraindications, at hospital discharge. For each therapy, the percentage of patientswith contraindications was significantly higher with increasingpatient risk. Even after adjusting for contraindications, use of evidence-based treatments in high-risk patients was significantly lower.

The team concluded that “the use of evidence-based therapies is lowerin patients with heart failure at higher risk of mortality, bothbecause of higher rates of contraindications to therapy andlower rates of use among eligible patients.” Therefore, they recommend expanding the evidence base for treating high-risk patients and developing effective strategies to ensure all high-risk patients receive appropriate therapies.