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

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.

• Authors: Poghni A Peri-Okonny, Xiaojuan Mi, Yevgeniy Khariton, Krishna K Patel, Laine Thomas, Gregg C Fonarow, Puza P Sharma, Carol I Duffy, Nancy M Albert, Javed Butler, Adrian F Hernandez, Kevin McCague, Fredonia B Williams, Adam D DeVore, J Herbert Patterson, John A Spertus
• Journal: JACC. Heart failure (JACC Heart Fail) Vol. 7 Issue 4 Pg. 350-358 (04 2019) ISSN: 2213-1787 [Electronic] United States
• PMID: 30738978 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Chemical References

• Adrenergic beta-Antagonists
• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors

Topics

• Adrenergic beta-Antagonists (administration & dosage)
• Adult
• Aged
• Aged, 80 and over
• Angiotensin Receptor Antagonists (administration & dosage)
• Angiotensin-Converting Enzyme Inhibitors (administration & dosage)
• Blood Pressure (drug effects, physiology)
• Cross-Sectional Studies
• Dose-Response Relationship, Drug
• Female
• Follow-Up Studies
• Heart Failure (drug therapy, physiopathology)
• Hospitalization (trends)
• Humans
• Male
• Middle Aged
• Prospective Studies
• Registries
• Stroke Volume (physiology)
• Treatment Outcome