Recommended Heart Failure Medications Are Underprescribed, Study Finds

A new study finds that more than one-third of heart failure (HF) patients do not receive recommended HF-specific medications within 30 days of diagnosis, and 29% of patients did not have a prescription filled for HF-specific treatments during the median 28-month period patients were followed up.

The finding, published in the May 2016 issue of the Journal of Managed Care & Specialty Pharmacy, confirms earlier studies that have suggested that medication recommendations by the American College of Cardiology Foundation/American Heart Association (ACCF/AHA) for a combination of angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor II blockers (ARB) and beta blockers (BB) are underprescribed for the management of HF. The guidelines also recommend aldosterone antagonists (AA) as add-on therapy for all patients with persisting symptoms despite treatment with ACEIs/ARBs and BBs.

The study used administrative claims of 235,758 newly diagnosed HF patients in the Truven Health MarketScan Commercial Claims and Encounters database and the Medicare Supplemental and Coordination of Benefits database of adult patients with at least 2 medical claims within 12 months on different dates corresponding to a HF diagnosis during the period from April 1, 2009, to March 31, 2012. Their mean age was 70.9 years with 46.5% aged 75 years or greater, and 51.6% of the cohort was female.

Overall, 41.8% of patients did not have any single prescription fill for HF-specific treatments of interest (ACEIs, ARBs, BBs and AAs) within 30 days of their first diagnosis. Even after taking diuretics into consideration, 35.5% of patients did not have an HF-specific treatment prescribed within 30 days of initial diagnosis. Among patients treated with HF-specific treatments, prescriptions for ACEI were filled by 46.2%, ARBs by 17.07%, BBs by 75.62%, and AAs by 9.83%. In all, 51.3% of patients had prescription fills for monotherapy, and 40% for bi-therapy. More than 80% of patients had treatment modification during the median 28 months of follow-up.

A total of 74% of patients had at least 1 all-cause hospitalization per year. Within 12 months after the index visit, 85.7% of these patients experienced an all-cause hospitalization, with 29.6% having HF-related hospitalization. More than 60% of patients continued on the same therapy after all-cause or HF hospitalization. More patients on multiple therapies remained on the same treatment compared with those treated with monotherapy after the first HF hospitalization. During the entire study period, 29% of patients did not have a prescription fill for HF-specific treatments.

The investigators say their findings suggest that despite ACCF/AHA recommendations of initiating treatment with a combination of 2 HF drug classes, only 40% of patients had a prescription fill for bi-therapy. Hospitalization did not have a major impact on HF therapy prescribing patterns. The analysis reveals the need for further research to better understand why there is a delay in HF treatment initiation and limited use of guideline-directed medical therapy after HF diagnosis.