Guideline‐Directed Medication Use in Patients With Heart Failure With Reduced Ejection Fraction in India: American College of Cardiology's PINNACLE India Quality Improvement Program

Abstract

Background Little is known about the use of guideline-directed medical therapy (GDMT) in outpatients with heart failure (HF) and a left ventricular ejection fraction (EF) ≤40% (HFrEF) in India. Our objective was to understand the use of GDMT in outpatients with HFrEF in India. Methods Practice Innovation and Clinical Excellence India Quality Improvement Program (PIQIP) is a registry for cardiovascular quality improvement in India supported by the American College of Cardiology Foundation. Between January 2008 to September 2014, we evaluated the documentation of the use of angiotensin-converting-enzyme-inhibitors (ACE-I)/angiotensin-receptor-blockers (ARB) and beta-blockers (BB) or both among outpatients with HFrEF seeking care in 10 centers enrolled in the PIQIP registry. Results Among 75,639 patients in the PIQIP registry, 34,995 had EF reported and 15,870 had an EF ≤40%. The mean age was 56 years (23% women). Hypertension, diabetes, coronary artery disease and myocardial infarction were present in 37%, 23%, 27% and 17%, respectively. ACE-I/ARB, BB, and both were documented in 33.5%, 34.9%, and 29.6% of patients, respectively. The documentation of GDMT was higher in men, and in patients ≥65 years and those with presence of hypertension, diabetes or coronary artery disease. The documentation of GDMT gradually increased over the study period. Conclusions Among patients enrolled in the PIQIP registry, about two-thirds of patients with EF ≤40% did not have documented receipt of GDMT. This study is an initial step towards improving adherence to GDMT in India, and highlights the feasibility of examining quality of care in HFrEF in a resource-limited setting.

Guideline-directed medical therapy in heart failure patients: impact of focused care provided by a heart failure clinic in comparison to general cardiology out-patient department

“…As little is known about the usage of GDMT in India, Practice Innovation and Clinical Excellence India Quality Improvement Program (PIQPIA) registry was started in India (supported by American College of Cardiology Foundation) in 10 centers to record the use of GDMT and stated that about two-third of the patients (EF < 40%) did not have the documented receipt of GDMT. Hence the focused care programs like HF clinics could help in the improved adherence to GDMT [ 26 ]. The results of PIQPIA showed that the GDMT was higher in patients of age greater than 65 years and in women, but in this study, the GDMT was given more in female and those below 60 years of age.…”

Signs, symptoms, and treatment patterns across serial ambulatory cardiology visits in patients with heart failure: insights from the NCDR PINNACLE® registry

“…Fortunately, with the large sample size in PINNACLE, we were able to look at the subgroup of patients with HF with reduced LVEF and found that medication changes in this group were similarly low. The loss of detailed medication information when data were transformed for analysis (i.e., type of diuretic and dosage information) significantly limited the ability to understand the scope of therapy adjustments occurring at clinic visits [ 18 , 28 , 29 ]. For example, a patient could have her furosemide dose increased and spironolactone added, but these medication changes would still be classified by PINNACLE as “unchanged” diuretic.…”

Secondary prevention of cardiovascular diseases in India: Findings from registries and large cohorts

“…This study was followed by a report on the use of guideline-directed medical therapy in heart failure patients. 10 The report included 15,870 patients from the PIQIP registry who had an ejection fraction (EF) less than 40%. The authors analyzed documented use of angiotensin converting-enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARBs), BBs or both among outpatients with heart failure and depressed EF.…”