Chronic heart failure guidelines: A critique.
- Author:
Abarquez Ramon F
;
Reganit Paul Ferdinand M
;
Chungunco Carmen N
;
Alcover Jean D
;
Punzalan Felix Eduardo R
;
Reyes Eugenio B
- Publication Type:Journal Article
- MeSH: Human; Heart Failure-Drug Therapy, Survival
- From: Acta Medica Philippina 2014;48(2):8-17
- CountryPhilippines
- Language:English
-
Abstract:
BACKGROUND: Chronic heart failure (HF) disease as an emerging epidemic has a high economic burden, hospitalization, readmission, morbidity rates despite many clinical practice guidelines recommendations.
OBJECTIVE: To show that the attributed survival and hospitalization-free event rates in the reviewed chronic HF clinical practice guidelines' Class I-A recommendations as "initial HF drug therapy" is basically "add-on HF drug therapy" to the "baseline HF drug therapy" thereby under-estimating the "baseline HF drug therapy" significant contribution to the clinical outcome.
METHODOLOGY: The references cited in the chronic HF clinical practice guidelines of the American Heart Association/American College of Cardiology (AHA/ACC), the Heart Failure Society of America (HFSA), and the European Society of Cardiology (ESC) were reviewed and compared with the respective guidelines' and other countries' recommendations.
RESULTS: The "baseline HF drug therapy" using glycosides and diuretics is 79-100% in the cited HF trials. The survival and hospitalization event-free rates attributed to the "baseline HF drug therapy" are 46-89% and 61.8-90%, respectively. The survival and hospitalization-free event rate of the "initial HF drug therapy" is 61-92.8% and 61.8-90%, respectively. Thus the survival and hospitalization event-free rates of the "add-on HF drug therapy" are 0.4-15% and 4.6% to 14.7%, respectively. The extrapolated "baseline HF drug therapy" survival is 8-51% based on a 38% natural HF survival rate for the time period.
CONCLUSION: The contribution of "baseline HF drug therapy" is relevant in terms of survival and hospitalization event-free rates compared to the HF Class 1-A guidelines proposed "initial HF drug therapy" which is in essence an "add-on HF drug therapy" in this analysis.