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• W2142955862 abstract "The concept of ‘optimal medical therapy’ relies on recommendations of current consensus-derived guidelines, most of which are supported by ‘level of evidence C’ (no scientific evidence).1 However, guidelines recommendations for commonly employed cardiovascular drugs often are based on strong evidence (‘level A’).2 Generally, such drugs are recommended at ‘target doses’ employed in the trials on which their putative efficacy and regulatory approval are based, and are considered ‘optimal medical therapy’. Information about the effectiveness of other doses, lower, or higher, seldom is available.Currently, reports of randomized controlled trials of new drugs in chronic heart failure (CHF) as well as in other conditions must quantitatively define the use of guidelines-recommended ‘optimal medical therapy’, usually as the proportion of patients who took these drugs, regardless of dose. However, in contemporary registries in CHF, for which therapy is particularly complex, large segments of the affected population fail to receive the recommended drugs and substantially less than half receive guidelines-based ‘target doses’. This is apparent from the Table 1 , in which doses of drugs for CHF actually employed, from the 12-country 2010 European Survey of the European Society of Cardiology3 are compared with ‘target doses’ of the same drugs from contemporary (2008) published guidelines.4 View this table:Table 1 Rate of use and dosages of the most frequently prescribed renin–angiotensin–aldosterone system blockers and beta-blockers. Modified from McMurray et al .2The use of beta-blockers for CHF is an example. In a recent trial—SHIFT—testing the effect of a pure heart rate slowing agent—ivabradine—against placebo in patients with CHF, maximized guidelines-recommended background therapy was mandated, specifically for beta-blockers, which also slow heart rate.5 In SHIFT, 89% of patients received a beta-blocker but only one-fourth reached the ‘target doses’, and only 56% achieved ≥50% of target. These results subsequently were echoed in CIBIS-ELD,6 …" @default.
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• W2142955862 date "2013-07-25" @default.
• W2142955862 modified "2023-10-06" @default.
• W2142955862 title "Should we revise our approach to 'optimal medical therapy'? The case of chronic heart failure" @default.
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• W2142955862 doi "https://doi.org/10.1093/eurheartj/eht279" @default.
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