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Observational Study
. 2019 Apr;7(4):350-358.
doi: 10.1016/j.jchf.2018.11.011. Epub 2019 Feb 6.

Target Doses of Heart Failure Medical Therapy and Blood Pressure: Insights From the CHAMP-HF Registry

Poghni A Peri-Okonny  1 , Xiaojuan Mi  2 , Yevgeniy Khariton  3 , Krishna K Patel  3 , Laine Thomas  2 , Gregg C Fonarow  4 , Puza P Sharma  5 , Carol I Duffy  5 , Nancy M Albert  6 , Javed Butler  7 , Adrian F Hernandez  2 , Kevin McCague  5 , Fredonia B Williams  8 , Adam D DeVore  2 , J Herbert Patterson  9 , John A Spertus  10
Affiliations
Observational Study

Target Doses of Heart Failure Medical Therapy and Blood Pressure: Insights From the CHAMP-HF Registry

Poghni A Peri-Okonny et al. JACC Heart Fail. 2019 Apr.

Abstract

Objectives: This study sought to determine the rate of use of target doses of foundational guideline-directed medical therapy (GDMT) in a contemporary cohort of patients with heart failure with reduced ejection fraction (HFrEF) across systolic blood pressure (SBP) categories.

Background: Patients with HFrEF are infrequently titrated to recommended doses of GDMT. The relationship between SBP and achieving GDMT target doses is not well studied.

Methods: Patients enrolled in the CHAMP-HF (Change the Management of Patients With Heart Failure) registry without documented intolerance to angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), angiotensin receptor-neprilysin inhibitors (ARNIs), and beta blockers (BBs) were assessed at enrollment. We estimated the proportion receiving target doses (% of target dose [95% confidence interval (CI)]) based on the most recent American College of Cardiology/American Heart Association/Heart Failure Society of America heart failure guidelines at baseline in all patients, and by SBP category (≥110 vs. <110 mm Hg).

Results: Of the 3,095 patients eligible for analysis, 2,421 (78.2%) had SBP ≥110 mm Hg. The proportion of patients receiving target doses were 18.7% (95% CI: 17.3% to 20.0%; BB), 10.8% (95% CI: 9.7% to 11.9%; ACEI/ARB), and 2.0% (95% CI: 1.5% to 2.5%; ARNI). Among those with SBP <110 mm Hg (n = 674), 17.5% (95% CI: 14.6% to 20.4%; BB), 6.2% (95% CI: 4.4% to 8.1%; ACEI/ARB), and 1.8% (95% CI: 0.8% to 2.8%; ARNI) were receiving target doses. Among those with SBP ≥110 mm Hg (n = 2,421), 19.0% (95% CI: 17.4% to 20.6%; BB), 12.1% (95% CI: 10.8% to 13.4%; ACEI/ARB), and 2.0% (95% CI: 1.5% to 2.6%; ARNI) were receiving target doses.

Conclusions: In a large, contemporary registry of outpatients with chronic HFrEF eligible for treatment with BBs and ACEI/ARB/ARNI, <20% of patients were receiving target doses, even among those with SBP ≥110 mm Hg.

Keywords: heart failure; systolic blood pressure; target dose.

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Figures

Figure 1:
Figure 1:. Distribution of percent target doses for each medication class in the overall cohort.
Figure 2:
Figure 2:. Distribution of percent target doses for each medication class among patients with SBP< 110mmHg.
Figure 3:
Figure 3:. Distribution of percent target doses for each medication class among patients with SBP≥110mmHg.
Figure 4:
Figure 4:. Distribution of percent of patients receiving target doses of BB and ACEI or ARB or ARNI among patients receiving BB and ACEI or ARB or ARNI.
See this image and copyright information in PMC

Comment in

References

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