How well are chronic heart failure patients being managed?

Abstract

Heart failure (HF) remains a major public health problem, affecting 5 million patients in the United States. The personal burden of HF includes debilitating symptoms, activity limitations, frequent hospitalizations, arrhythmias, and increased mortality. Despite the compelling scientific evidence that angiotensin-converting enzyme inhibitors, beta-blockers, and aldosterone antagonists reduce hospitalizations and mortality in patients with HF, these life-prolonging therapies continue to be underutilized. Device therapy for HF, including implantable cardioverter defibrillators and cardiac resynchronization therapy, has recently been demonstrated to also result in substantial mortality reduction. Accurate evaluation of patients with HF is critical for the appropriate selection and monitoring of therapy to reduce symptoms as well as for the prevention of recurrent hospitalizations. A number of studies in a variety of clinical settings have documented that a significant proportion of patients with HF are not receiving treatment with guideline-recommended, evidence-based therapies. Treatment gaps have also been documented in providing other components of care for patients with HF, including assessment for congestion and patient education. Recent studies demonstrate that hospital-based systems can improve medical care and education of hospitalized HF patients and accelerate use of evidence-based, guideline-recommended therapies by administering them before hospital discharge. HF disease management programs have also been shown to improve HF treatment, resulting in substantial reduction in hospitalizations and mortality. Application of validated and reproducible noninvasive techniques to monitor patients with chronic HF is an important step in maximizing interventions to improve outcomes in this patient population. Further efforts are clearly needed to improve the monitoring of HF patients in the hospital and outpatient settings, as well as to ensure the implementation of effective strategies and systems that increase the use of evidence-based therapies, in order to reduce the substantial HF morbidity and mortality risk.