Chronic Heart Failure Guidelines: A Critique

Ramon F. Abarquez, Jr., Paul Ferdinand M. Reganit, Carmen N. Chungunco, 
Jean D. Alcover, Felix Eduardo R. Punzalan and Eugenio B. Reyes

Section of Cardiology, Department of Medicine, College of Medicine and
Philippine General Hospital, University of the Philippines Manila

Background. Chronic heart failure (HF) disease as an emerging epidemic has a high economic burden, hospitalization, readmission, morbidity rates despite many clinical practice guidelines recommendations.

Objective. To show that the attributed survival and hospitalization-free events in the reviewed chronic HF clinical practice guidelines' Class I-A recommendations as "initial HF drug therapy" is basically "add-on HF drug therapy" to the "baseline HF drug therapy" thereby under-estimating the "baseline HF drug therapy" significant contribution to the clinical outcome.

Methodology. The references cited in the chronic HF clinical practice guidelines of the American Heart Association/American College of Cardiology (AHA/ACC), the Heart Failure Society of America (HFSA), and the European Society of Cardiology (ESC) were reviewed and compared with the respective guidelines' and other countries' recommendations.

Results. The "baseline HF drug therapy" using glycosides and diuretics is 79-100% in the cited HF trials. The survival and hospitalization event-free rates attributed to the "baseline HF drug therapy" are 46-89% and61.8-90%, respectively. Thus the survival and hospitalization-free event rate of the "add-on HF drug therapy" are 0.4-15% and 4.6% to 14.7%, respectively. The extrapolated "baseline HF drug therapy" survival is 8-51% based on a 38% natural HF survival rate for the time period.

Conclusion. The contribution of "baseline HF drug therapy" is relevant in terms of survival and hospitalization event-free rates compared to the HF Class 1-A guidelines proposed "initial HF drug therapy" which is in essence an "add-on HF drug therapy" in this analysis.

Keywords: heart failure, guidelines, critique