Use of evidence-based therapy and survival in heart failure in Sweden 2003-2012

• Published in: European journal of heart failure Vol. 18; no. 5; pp. 503 - 511
• Main Authors: Thorvaldsen, Tonje, Benson, Lina, Dahlström, Ulf, Edner, Magnus, Lund, Lars H.
• Format: Journal Article
• Language: English
• Published: Oxford, UK John Wiley & Sons, Ltd 01.05.2016
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Aged; Aged, 80 and over; Angiotensin Receptor Antagonists - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Cardiac Resynchronization Therapy; Defibrillators, Implantable; Evidence-Based Medicine; Evidence-based therapy; Female; Guidelines; Heart failure; Heart Failure - therapy; Humans; Implementation; Male; Medicin och hälsovetenskap; Middle Aged; Mineralocorticoid Receptor Antagonists - therapeutic use; Outcomes; Registries; Survival Rate; Sweden; Utilization; Heart failure; Utilization; Evidence-based therapy; Implementation; Outcomes; Guidelines
• ISSN: 1388-9842; 1879-0844; 1879-0844
• DOI: 10.1002/ejhf.496

Aims In heart failure with reduced ejection fraction, drug and device therapy improve survival. We studied contemporary trends in utilization of evidence‐based therapy and associated survival. Methods and results We studied 5908 patients with NYHA class II–IV heart failure, EF <30%, and duration of heart failure ≥6 months registered in the Swedish Heart Failure Registry between 2003 and 2012. Regression using generalized estimation equations was used to examine temporal trends in crude and risk‐adjusted rates of utilization of evidence‐based heart failure therapy and 30‐day, 1‐year, and 3‐year survival. In 2003 vs. 2012, the risk‐adjusted use of therapy and P‐values for trends were as follows: renin–angiotensin system antagonists, 88% vs. 86% (P = 0.091); beta‐blockers, 85% vs. 93% (P = 0.008); mineralocorticoid receptor antagonists, 53% vs. 42% (P < 0.001); CRT, 2.4% vs. 8.2% (P = 0.074); and implantable cardioverter‐defibrillators, 4.0% vs. 10.7% (P = 0.004). During the same period, the risk‐adjusted 30‐day, 1‐year, and 3‐year survival was 92% vs. 94% (P = 0.532), 81% vs. 77% (P = 0.260), and 58% vs. 54% (P = 0.425), respectively. Conclusions In this large nationwide registry, over the last decade the use of evidence‐based drug therapy was high and remained stable over time, but, despite an increased use of device therapy, the absolute use was poor. This was associated with an absence of improvement in survival. The improvements in therapy and prognosis over the last generation may be levelling off, and efforts should be directed at improving implementation of evidence‐based therapy.