Management e qualità Come è cambiata la terapia farmacologica nel registro IN-CHF dal 1995 al 2005

In the last years the treatment of heart failure has radically changed due to the results of multicenter clinical trials. The antagonism of neurohormonal systems has proved to be the only strategy, which favorably modifies the prognosis of the patients with heart failure. Particularly, the effectiveness of angiotensin-converting enzyme (ACE)-inhibitors and beta-blockers has been proven in patients with heart failure and left ventricular dysfunction; more recently, angiotensin receptor blockers (ARBs) and aldosterone blockers have shown to improve the outcome in heart failure. The public health importance of translating this body of evidence of research into clinical practice is paramount. We used data from the IN-CHF registry to examine changes in the use of pharmacological treatment from 1995 to 2005. The proportion of patients receiving an ACE-inhibitor was slightly higher in the 19952000 than after but this difference is not statistically significant. The use of “recommended therapies” as beta-blockers, aldosterone antagonists and ARBs increased significantly in these 10 years. The use of beta-blockers also increased significantly among elderly patients and patients in advanced NYHA class. Patients treated with the combination of ACE-inhibitors and ARBs are very few (1.1%), even if this association is now recommended by the European Society of Cardiology guidelines. The same analysis repeated after the CHARM and Val-HeFT publication shows that this association is used in 2.0% of the patients. The proportion of patients treated with a beta-blocker plus ACE-inhibitors plus ARB is only 0.8%. Use of digitalis and calcium channel blockers fell continuously from 1995 whereas use of diuretics and anticoagulants remained relatively constant. Statins are becoming widely used in this population (from 5 to 20%) even if the information on the effect of these drugs in heart failure is still incomplete.