Examining risk factor goal attainment and adherence to treatment among US heart failure patients: the National Health and Nutrition Examination Survey 2007-2010

Abstract

Purpose: Data are limited regarding the adequacy of risk factor control and adherence to recommended therapies among adults with heart failure (HF). We evaluated the adequacy of risk factor control and adherence to recommended pharmacologic therapies among non-institutionalized US adults with HF.

Methods: We examined data from US adults aged 18 years and older with a self-reported history of HF from the US National Health and Nutrition Examination Survey 2007-2008 and 2009-2010. We estimated the proportions of subjects who reported recommended lifestyle modification and medications and were at target levels of blood pressure, low-density lipoprotein cholesterol (LDL-C), and hemoglobin A1c.

Results: Among 371 subjects with HF in our study, 73.7 % were non-smokers, while only 69.1, 51.9, and 56.2 % were at goal for blood pressure, LDL-C, and hemoglobin A1c (if diabetic), respectively; only 9.0 % were at goal for all measures. The proportions of non-smokers were lower in males (p < 0.01) and lowest in non-Hispanic blacks (p < 0.01). Subjects with less than a high school education (p < 0.05) were least likely to be at recommended blood pressure levels. The proportions exercising moderately, with recommended alcohol and sodium intakes, and with a normal body mass index were 8.3, 41.4, 28.9, and 17.5 %, respectively. 83.3 % of HF patients were taking only one of the recommended four classes of drugs [β-blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs), diuretics, and digoxin]; only 50.1 % were additionally on a lipid-lowering agent.

Conclusion: We observed a significant gap between adherence and control of HF risk factors and treatment among non-institutionalized US adults.