Influence of Renal Function on the Use of Guideline-Recommended Therapies for Patients With Heart Failure

Heywood, J. Thomas; Fonarow, Gregg C.; Yancy, Clyde W.; Albert, Nancy M.; Curtis, Anne B.; Stough, Wendy Gattis; Gheorghiade, Mihai; McBride, Mark L.; Mehra, Mandeep R.; O'Connor, Christopher M.; Reynolds, Dwight; Walsh, Mary Norine

doi:10.1016/j.amjcard.2009.12.016

« Previous Next »American Journal of Cardiology
Volume 105, Issue 8 , Pages 1140-1146, 15 April 2010

Influence of Renal Function on the Use of Guideline-Recommended Therapies for Patients With Heart Failure

J. Thomas Heywood, MD
- Scripps Clinic, La Jolla, California
- Corresponding author: Tel: (858) 554-5588; fax: (858) 554-5197
Gregg C. Fonarow, MD
- University of California, Los Angeles, Medical Center, Los Angeles, California
Clyde W. Yancy, MD
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, Texas
Nancy M. Albert, PhD, RN
- Cleveland Clinic Foundation, Cleveland, Ohio
Anne B. Curtis, MD
- University of South Florida College of Medicine, Tampa, Florida
Wendy Gattis Stough, PharmD
- Campbell University School of Pharmacy, Research Triangle Park, North Carolina
- Duke University Medical Center, Durham, North Carolina
Mihai Gheorghiade, MD
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois
Mark L. McBride, PhD
- Outcome Sciences, Inc., Cambridge, Massachusetts
Mandeep R. Mehra, MD
- University of Maryland, Baltimore, Maryland
Christopher M. O'Connor, MD
- Duke University Medical Center, Durham, North Carolina
Dwight Reynolds, MD
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
Mary Norine Walsh, MD
- The Care Group, LLC, Indianapolis, Indiana

Received 19 October 2009; received in revised form 3 December 2009; accepted 3 December 2009. published online 22 February 2010.

Guidelines have been established for the treatment of patients with heart failure (HF) and left ventricular dysfunction, but renal dysfunction might limit adherence to these guidelines. Few data have characterized the use of guideline-recommended therapy for patients with HF, left ventricular dysfunction, and renal dysfunction who are treated in outpatient settings. The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) was a prospective study of patients receiving treatment as outpatients in cardiology practices in the United States. The rates of adherence to 7 guideline-recommended therapies were evaluated for patients with a left ventricular ejection fraction of ≤35%. The estimated glomerular filtration rate was estimated using the Modification of Diet in Renal Disease formula for 13,164 patients who were categorized as having stage 1 through stage 4/5 chronic kidney disease (CKD). More than 1/2 (52.2%) of the patients had stage 3 or 4/5 CKD. Older patients and women were at increased risk of higher stage CKD, and the rates of co-morbid health conditions were significantly greater among patients with more severe CKD. The patients with more severe CKD were significantly less likely to receive all interventions except cardiac resynchronization therapy. However, multivariate analysis controlling for patient characteristics revealed that the severity of CKD was an independent predictor of adherence to angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy but not to any of the 6 other guideline-recommended measures. In conclusion, these results confirm that CKD is common in patients with HF and left ventricular dysfunction but is not independently associated with adherence to guideline-recommended therapy in outpatient cardiology practices, with the exception of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy.