| Influence of renal function on the use of guideline-recommended therapies for patients with heart failure. | |
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MedLine Citation:
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PMID: 20381667 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Guidelines have been established for the treatment of patients with heart failure (HF) and left ventricular dysfunction, but renal dysfunction might limit adherence to these guidelines. Few data have characterized the use of guideline-recommended therapy for patients with HF, left ventricular dysfunction, and renal dysfunction who are treated in outpatient settings. The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) was a prospective study of patients receiving treatment as outpatients in cardiology practices in the United States. The rates of adherence to 7 guideline-recommended therapies were evaluated for patients with a left ventricular ejection fraction of < or = 35%. The estimated glomerular filtration rate was estimated using the Modification of Diet in Renal Disease formula for 13,164 patients who were categorized as having stage 1 through stage 4/5 chronic kidney disease (CKD). More than 1/2 (52.2%) of the patients had stage 3 or 4/5 CKD. Older patients and women were at increased risk of higher stage CKD, and the rates of co-morbid health conditions were significantly greater among patients with more severe CKD. The patients with more severe CKD were significantly less likely to receive all interventions except cardiac resynchronization therapy. However, multivariate analysis controlling for patient characteristics revealed that the severity of CKD was an independent predictor of adherence to angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy but not to any of the 6 other guideline-recommended measures. In conclusion, these results confirm that CKD is common in patients with HF and left ventricular dysfunction but is not independently associated with adherence to guideline-recommended therapy in outpatient cardiology practices, with the exception of angiotensin-converting enzyme inhibitor/angiotensin receptor blocker therapy. |
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Authors:
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J Thomas Heywood; Gregg C Fonarow; Clyde W Yancy; Nancy M Albert; Anne B Curtis; Wendy Gattis Stough; Mihai Gheorghiade; Mark L McBride; Mandeep R Mehra; Christopher M O'Connor; Dwight Reynolds; Mary Norine Walsh |
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Publication Detail:
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Type: Comparative Study; Journal Article Date: 2010-02-20 |
Journal Detail:
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Title: The American journal of cardiology Volume: 105 ISSN: 1879-1913 ISO Abbreviation: Am. J. Cardiol. Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-04-12 Completed Date: 2010-06-15 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0207277 Medline TA: Am J Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1140-6 Citation Subset: AIM; IM |
Copyright Information:
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Copyright 2010. Published by Elsevier Inc. |
Affiliation:
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Scripps Clinic, La Jolla, CA, USA. Heywood.Tom@scrippshealth.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Cardiovascular Agents / therapeutic use* Creatinine / blood* Echocardiography Female Follow-Up Studies Glomerular Filtration Rate / physiology* Guideline Adherence* Heart Failure / complications, physiopathology, therapy* Humans Kidney Failure, Chronic / etiology, physiopathology, prevention & control Magnetic Resonance Imaging Male Middle Aged Outpatients Practice Guidelines as Topic* Prognosis Prospective Studies Renal Insufficiency / blood, complications*, physiopathology Stroke Volume Ventricular Dysfunction, Left / complications, physiopathology, therapy Ventricular Function, Left |
| Chemical | |
Reg. No./Substance:
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0/Cardiovascular Agents; 60-27-5/Creatinine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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