In a recent issue of the Journal of the American Medical Association, researchers from Ontario reported that, among patients with heart failure, standard therapy with ACE inhibitors and beta blockers are more often withheld from high-risk patients than lower risk patients. While lower risk patients fared better, in terms of more often receiving recommended therapy, even in this group the usage of appropriate drugs was suboptimal.
Both ACE inhibitors and beta blockers have been established to significantly prolong survival in patients with heart failure, and recent guidelinesfrom the American Heart Association and the American College of Cardiology emphasize the use of these drugs in all patients with heart failure. In the Ontario study, however, while 86% of lower-risk patients received an ACE-inhibitor-like drug, only 60% of high-risk patients received these drugs. While these proportions are clearly suboptimal, the numbers with beta blockers (probably the most important life-prolonging therapy available for heart failure) were even worse. Beta blockers were given to only 40% of lower-risk patients and only 24% of high-risk patients. Among high-risk patients, a full 27% are receiving neitherACE inhibitors or beta blockers.
While this study was conducted in Canada, past studies have shown that American and European doctors tend to behave similarly with regard to the treatment of heart failure, and it is quite likely that these results reflect the standard of practice for Western medicine.
DrRich comments:
Despite incontrovertible evidence that ACE inhibitors and beta blockers strongly improve the outcome in patients with heart failure, and despite widely-publicized guidelines to that effect, a lot of doctors still aren't getting it. If you or a loved one has heart failure and are not receiving both an ACE inhibitor and a beta blocker, talk to your doctor about it. If you get some type of negative response (e.g., "you're just not a good candidate," or "the guidelines don't apply to you") then get another opinion from a different doctor.
