Heart Failure Treatment Gaps: Q&A With Advisory Board Member Ileana Piña, MD

Now, more research is being conducted to evaluate the efficacy of starting exercise later in a patient’s life. One such study that was presented at the American Heart Association meeting in November indicates that even modest increases in physical activity at later stages can help.⁵ On the flip side, we’re also examining the benefits of exercising earlier in life, such as the CARDIA study.⁶

Outside of the realm of heart failure, there is evidence to suggest that not enough physicians are utilizing optimal medical therapy and instead pushing for surgical interventions such as percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).⁷

For example, both the US CathPCI Registry and Dartmouth Atlas found that antianginal therapy was being underprescribed in patients undergoing PCI. Only 48.3% of patients were taking 1 medication, 16.1% were taking 2 medications, and 2.8% were taking 3 or more medications.⁷

Likewise, at a large cardiac center in the United Kingdom, clinicians followed patients with stable coronary artery disease (CAD) referred for PCI or angiography with follow-up on PCI and found they were treated with aspirin (95%), beta-blockers (71%), angiotensin-converting enzyme (ACE) inhibitors (48%), and statins (87%). Among this group of patients, 32% had a resting heart rate ≥70 bpm—a condition known to be associated with adverse cardiovascular (CV) outcomes in patients with CAD.⁷

In addition, hospital admission can be an opportunity to reassess cardioprotective medications.  In another study that gathered data from the Blue Cross Blue Shield of Michigan Cardiovascular Consortium PCI registry, researchers assessed therapies before and after PCI in patients with stable CAD undergoing revascularization. Prior to PCI, optimal medical therapy was only used in 53%, but at discharge, this rate increased to 82.1%.⁸

Q: In light of a recent editorial you co-authored and published in Revista Espanola de Cardiologia, how do you believe clinicians and patients can improve heart failure prevention efforts? And are efforts being sustained or decreasing?

A: Efforts to have access to quality care have increased throughout the world. Spain is a great example.^9-11

In 2014, investigators from the National Centre for Epidemiology, Carlos III Institute of Health of Madrid examined rates of hospitalization due to incident ischemic heart disease. They found that from 1982 to 2009, hospitalization rates increased, with a spike in 1997, and then decreased by 52% until 2009. This continuous rise was cut in half, in part because of a decline in smoking and an increase in vascular risk drug therapy—specifically, use of statins and antihypertensive, antiplatelet, and antidiabetic drugs.⁹