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Heart failure patients at highest risk of death least likely to get drug treatment


Heart failure patients who are at the highest risk of death are the least likely to receive life-saving medications, a new study from the Institute for Clinical Evaluative Sciences (ICES) shows.

“Previous studies have found that high risk patients with heart attacks and coronary artery disease may be least likely to receive cholesterol-lowering therapy with statins. In this study, we examined patients with heart failure, a condition with high mortality rates, for which the mainstay of treatment is drug-based. We looked at whether high risk patients with heart failure were less likely to receive potentially life-sustaining drug therapies,” said lead author and ICES research fellow Dr. Douglas Lee.

To conduct the study, researchers tracked 1,418 heart failure patients 79 years of age or younger who were discharged from hospital in Ontario between 1999 and 2001. They examined how many high, intermediate, and low risk patients were prescribed angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), or beta-blockers at hospital discharge and 90 days following hospital discharge.

The results showed that among heart failure patients with a higher risk of death, the prescription rates of ACEIs, ARBs and beta-blockers decreased, both at hospital discharge and within 90 days following hospital discharge. The pattern of lower rates of drug administration in heart failure patients at increasing risk was maintained up to one year following hospital discharge.

“We do not know what the main reasons are for the inverse relationship between risk and treatment. However, there may be several potential explanations,” said Dr. Lee. “Physicians may be uncertain about the risks versus the benefits in treating high risk heart failure patients with these medications. The care of heart failure patients can be complex because of their age, other cardiac issues and comorbid conditions, and therefore, physicians may be focused on these other issues in heart failure patients with multiple conditions.

“However, higher risk patients have a great need for effective treatment and the benefits of these medications are well-established. Increasing the use of these drug therapies in higher risk patients may improve outcomes.”

The study, “Risk-treatment mismatch in the pharmacotherapy of heart failure”, is in the September 14, 2005 issue of the Journal of the American Medical Association (JAMA).

Author affiliations: ICES (Drs. Lee, Tu, Juurlink, Alter, Ko, Austin, Stukel, and Laupacis and Ms. Chong); Department of Health Policy, Management and Evaluation, University of Toronto (Drs. Tu, Juurlink, Ko, Austin, Alter, Stukel, and Laupacis); Sunnybrook and Women’s College Health Sciences Centre (Drs. Tu, Juurlink, Ko, Alter, and Laupacis); Framingham Heart Study of the National Heart, Lung, and Blood Institute, National Institutes of Health (Drs. Lee and Levy).

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.


  • Julie Argles
  • Media Relations Officer, ICES
  • (416) 480-4780 or cell (416) 432-8143


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