Effect of heart failure program on cardiovascular drug utilization and dosage in patients with chronic heart failure

Background: Utilization and dosage of angiotensin-converting enzyme (ACE) i nhibitors in patients with chronic heart failure (CHF) remain low. Recent d ata suggest that care of patients with CHF in specialized heart failure pro grams is associated with improved clinical outcomes. Hypothesis: Specialized heart failure care is associated with better utiliz ation and higher dose of cardiovascular drugs. Methods: Data from 133 patients with CHF referred to a heart failure progra m were analyzed. Mean functional class 3.1 +/- 0.5, left ventricular ejecti on fraction 19 +/- 8. Utilization and doses of cardiovascular drugs were ex amined at initial evaluation and at last visit, after an average period of 17 +/- 14 months. Hospitalization and survival data were determined. Results: Utilization of ACE inhibitors and angiotensin receptor blockers in creased from 87 to 100% (p<0.001). Average daily dose increased by 60%, fro m the equivalent of captopril 105 +/- 78 mg to 167 +/- 86 mg (p < 0.001). U tilization of the following drugs increased significantly: beta blockers (1 6-37%, p < 0.001), metolazone (10-23%, p = 0.007), spironolactone 1-36%, p < 0.001), amiodarone 17-15%, p = 0.05), hydralazine (1-9%, p = 0.004), and nitrates (20-33%, p = 0.03). One-year survival was 90%. The 3- and 6-month hospitalization rates for heart failure were 4 and 7%, and for all cardiova scular causes they were 6 and 11%, respectively. Conclusions: Care of patients with CHF in a specialized heart failure progr am was associated with significant increase in the utilization and doses of all beneficial cardiovascular drugs, especially ACE inhibitors. It was als o associated with excellent clinical outcomes.