Guideline-recommended therapy, including beta-blocker utilization, in patients with chronic heart failure: results from a Canadian community hospital heart function clinic

Guideline-recommended therapy, including beta-blocker utilization, in patients with chronic heart failure: results from a Canadian community hospital heart function clinic Michael Heffernan Division of Cardiology, Oakville Trafalgar Memorial Hospital, Oakville, ON, Canada Abstract: A comprehensive analysis of beta-blocker utilization and other guideline-recommended therapies for the treatment of chronic heart failure in a Canadian community hospital heart function clinic has not been undertaken and was, therefore, the focus of this study. The proportion of patients who would be potential candidates for ivabridine and sacubitril–valsartan therapy as a result of fulfilling the criteria for enrollment in either the Systolic Heart failure treatment with the If inhibitor ivabradine Trial (SHIFT) study (left-ventricular ejection fraction [LVEF] >35%, sinus rhythm, New York Heart Association II–IV) or the Prospective Comparison of angiotensin receptor-neprilysin inhibitor (ARNI) with angiotensin-converting enzyme inhibitor (ACEI) to determine impact on global Mortality and Morbidity in Heart Failure (PARADIGM-HF) study (LVEF <40%, New York Heart Association II–IV, glomerular filtration rate >30 mL/min), was also assessed. A retrospective cross-sectional analysis was carried out in all 371 patients treated in this community heart function clinic for at least a 12-month period. The patients were elderly (mean age 74±13.3 years) and predominately male (61.5%) with symptomatic (82.5%) moderate left-ventricular dysfunction (LVEF 45.4%±15.6%). A substantial proportion of the patients also had a diagnosis of atrial fibrillation (52.8%). The total use of beta blockers exceeded 87%, while 100% of patients without a documented contraindication or intolerance to a beta blocker received therapy. Adherence to other guideline-recommended pharmacotherapies specifically for heart failure with reduced left ventricular ejection was high: 86.1% of the eligible patients were treated with an ACEI/angiotensin receptor blocker and 61.9% received a mineralcorticoid receptor antagonist. We determined that 13.7% of the complement of this heart function clinic could be expected to benefit from ivabridine therapy based on the results of the SHIFT study. In addition, 28.3% of the clinic patients would be eligible for the initiation of sacubitril–valsartan based on the PARADIGM-HF criteria. Keywords: chronic heart failure, community hospital, heart function clinic, beta blocker, ivabridine, neprilysin inhibitor