Clinical systolic heart failure (HF) guidelines specify recommendations for ACE inhibitors (ACEI), angiotensin receptor blockers (ARB) and beta blockers according to doses used in clinical trials. However, many HF patients remain suboptimally treated.
Crissinger and colleagues sought to determine which provider type, between an interprofessional HF team, non-HF cardiologists and primary care physicians (PCP), most optimally manages HF medications and doses. A retrospective chart review was performed on adult patients at an academic county hospital with an ejection fraction ≤40% and a diagnosis of HF, seen by a single provider type (HF team, cardiologist or PCP) at least twice within a 12-month period.
Utilization rates of any ACEI/ARB and any beta blocker were robust across provider types, though evidence-based ACEI/ARB and beta blocker were greatest from the HF team. Doses of evidence-based therapies dropped markedly in the non-HF team groups. The percent of patients prescribed optimal doses of an evidence-based ACEI/ARB AND beta blocker was 69%, 33% and 25% for the HF team, cardiologists and PCPs, respectively (p < 0.0167). Patients followed by the HF team were more frequently prescribed evidence-based medications at optimal doses.
The findings of this study support the use of specialized interprofessional HF teams to attain greater adherence to evidence-based recommendations in treating systolic HF.