Not All Heart Failure Patients Receive Optimal Therapy: Women and Elderly Less Like to Get ICDs

Not All Heart Failure Patients Receive Optimal Therapy: Women and Elderly Less Like to Get ICDs

September 17, 2007–MINNEAPOLISBaseline data from the largest study of United States-based heart failure (HF) patients in the outpatient setting demonstrate significant gaps and variation in medical care, particularly for women and the elderly. Findings from the Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) study were presented today in a poster session at the Heart Failure Society of America Annual Scientific Meeting. 

“This is the first study of its kind to document the extent to which heart failure patients in the outpatient setting are receiving optimal treatment, as defined by the most recent treatment guidelines,” said Gregg C. Fonarow, MD, Co-Chair of the IMPROVE HF Scientific Steering Committee and Professor of Medicine at the University of California at Los Angeles. 

“The IMPROVE HF data represents real-world management of heart failure patients in a variety of outpatient cardiology practices from all regions of the United States. It shows us that there are gaps and significant variation across these practices in the use of evidence-based, guideline-recommended therapies in eligible patients, especially female and elderly patients,” added Fonarow.

“These data signal an opportunity for the medical community to improve the quality of care for the country’s five million heart failure patients,” said Clyde Yancy, MD, Co-Chair of the IMPROVE HF Scientific Steering Committee and Medical Director, at the Baylor Heart and Vascular Institute, Baylor University Medical Center, in Dallas, Texas.

Substantial variation exists across outpatient cardiology practices in the type of treatment provided to heart failure patients.  Conformity with performance measures (in eligible patients only) for practices (10th-90th percentiles) include:

  • Cardiac resynchronization therapy (CRT), including both CRT-Defibrillation and CRT-Pacing only devices (0-80%)

  • Implantable cardioverter defibrillator (ICD) therapy, including both ICD only and CRT-D devices (26.3-76.2%)

  • Patient education (29.1-88.9%)

Women were less likely than men to receive an implantable cardioverter defibrillator (ICD) when indicated (43.1% vs. 53%; p<0.001), education about their condition (59.7% vs. 61.9%; p=0.026), or anticoagulation treatment for atrial fibrillation (64.8% vs. 70.6%; p=0.004).

Older patients were less likely than younger patients to receive certain types of guideline-indicated interventions—particularly ICD/CRT-D therapy (43% in patients >76 years,57.2% in patients >64 to <76 years, 52% in patients <64 years; p<0.001.)


IMPROVE HF is the first of its kind, large-scale, prospective study involving approximately 40,000 HF patients from approximately 150 cardiology practices in the U.S.  Among other things, the study is designed to:

  • Characterize the management of chronic systolic heart failure (EF ≤35 percent) in the outpatient care setting

  • Provide insight into the issues that impede implementation of HF treatment guidelines, such as the documentation of NYHA (New York Heart Association) functional class

  • Identify methods and tools that will improve the quality of HF care in the outpatient setting, such as patient education

Additional information about the IMPROVE HF study is available at:

About Heart Failure and Treatment Guidelines

Heart failure is typically a late manifestation of one or more other cardiovascular diseases, including coronary artery disease (CAD), hypertension, and valvular disease. Chronic heart failure occurs when the heart is unable to pump enough blood to sustain adequate circulation in the body’s tissues.  Approximately 5.2 million Americans suffer from HF and more than 550,000 new cases are estimated to develop each year.  Heart failure is the most costly cardiovascular disease in the U.S., at an estimated $40 billion per year. Estimates for the global population (22 million) are near $80 billion.

In 2001, the American College of Cardiology and American Heart Association (ACC/AHA) published the first guidelines for the evaluation and management of chronic heart failure in adults.  The ACC/AHA published updated HF treatment guidelines in 2005.  In 2006, the Heart Failure Society of America (HFSA) released guidelines for living with and treating HF, which complement the ACC/AHA guidelines that recommend device therapy as standard of care for HF patients already on optimal medical therapy who meet CRT and/or ICD indications. The use of published HF treatment guidelines has been shown to reduce the risk of death by up to 77 percent. 

NOTE: This study is sponsored by Medtronic, Inc.

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