Strategies to improve the use of evidence-based heart failure therapies.

Patients with heart failure (HF) face a very high risk of hospitalizations, arrhythmias, and mortality. Despite compelling scientific evidence that angiotensin-converting enzyme inhibitors, b-blockers, and aldosterone antagonists reduce hospitalizations and mortality in HF patients, these life-prolonging therapies continue to be underutilized. Recently, device therapy for HF, including implantable cardioverter-defibrillators and cardiac resynchronization devices, has also been demonstrated to result in substantial mortality reduction. A number of studies in a variety of clinical settings have documented that a significant proportion of HF patients are not receiving treatment with these guideline-recommended, evidence-based therapies when guided by conventional care. Treatment gaps in providing other components of HF patient care, including patient education, have also been documented. The demonstration that initiation of cardiovascular protective medications before hospital discharge results in a marked increase in treatment rates, improved long-term patient compliance, and better clinical outcomes has led to the revision of national guidelines to endorse this approach as the standard of care. Recent studies demonstrated 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. Further efforts are needed to ensure the implementation of effective strategies and systems that increase the use of evidence-based therapies in the hospital and outpatient settings to reduce the substantial HF morbidity and mortality risk.