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(Circulation. 2007;116:693-695.)
© 2007 American Heart Association, Inc.

Editorial

Patients’ Persistence of Evidence-Based Treatment of Chronic Heart Failure

A Treatment Paradox

Inger Ekman, RN, PhD; Karl Swedberg, MD, PhD

From the Institute of Health and Care Sciences (I.E.) and the Department of Emergency and Cardiovascular Medicine (K.S.), Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.

Correspondence to Dr Karl Swedberg, Department of Medicine, Sahlgrenska University Hospital/Östra, 416 85 Göteborg, Sweden. E-mail karl.swedberg@gu.se

Key Words: Editorials • Heart Failure • Morbidity • Mortality

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Chronic heart failure (CHF) is associated with high morbidity, mortality, disability, and reduced quality of life.¹ These problems linked to CHF are still valid despite dramatic beneficial improvements in treatment in the past 10 to 15 years. Treatment of CHF includes not only pharmacological options but also various devices for patients with more pronounced symptoms and/or myocardial systolic dysfunction. In the major Guidelines on Treatment of Chronic Heart Failure it is stated that optimal treatment requires a combination of neurohormonal agents.² Accordingly, even if the benefits of treatment have improved, the management mode of these therapies has become increasingly more complicated. In cross-sectional studies, it has been reported that treatments are underused, both with regard to agents and dose levels.³ It has been suggested that the reasons for this situation are the complexity of the combination of agents and the hesitancy of the treating physician or the patient. An understanding of how treatments are prescribed, delivered, and comprehended by the patient is important if prognosis is to be further improved.

Article p 737

The beneficial effect of the recommended pharmacological approach to treatment of patients with CHF is now even reflected in population registries with decreasing mortality.⁴ It is therefore obvious that neglect or underuse of these treatments is not good medical practice, and there should be a mandate for everyone who cares for patients with heart failure to tailor optimal treatment to each patient. An important barrier to success in this process is when patients are discharged from hospital . . . [Full Text of this Article]

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