Medical Therapy for Heart Failure With Reduced Ejection Fraction: The CHAMP-HF Registry

J Am Coll Cardiol. 2018 Jul 24;72(4):351-366. doi: 10.1016/j.jacc.2018.04.070.


Background: Guidelines strongly recommend patients with heart failure with reduced ejection fraction (HFrEF) be treated with multiple medications proven to improve clinical outcomes, as tolerated. The degree to which gaps in medication use and dosing persist in contemporary outpatient practice is unclear.

Objectives: This study sought to characterize patterns and factors associated with use and dose of HFrEF medications in current practice.

Methods: The CHAMP-HF (Change the Management of Patients with Heart Failure) registry included outpatients in the United States with chronic HFrEF receiving at least 1 oral medication for management of HF. Patients were characterized by baseline use and dose of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB), angiotensin receptor neprilysin inhibitor (ARNI), beta-blocker, and mineralocorticoid receptor antagonist (MRA). Patient-level factors associated with medication use were examined.

Results: Overall, 3,518 patients from 150 primary care and cardiology practices were included. Mean age was 66 ± 13 years, 29% were female, and mean EF was 29 ± 8%. Among eligible patients, 27%, 33%, and 67% were not prescribed ACEI/ARB/ARNI, beta-blocker, and MRA therapy, respectively. When medications were prescribed, few patients were receiving target doses of ACEI/ARB (17%), ARNI (14%), and beta-blocker (28%), whereas most patients were receiving target doses of MRA therapy (77%). Among patients eligible for all classes of medication, 1% were simultaneously receiving target doses of ACE/ARB/ARNI, beta-blocker, and MRA. In adjusted models, older age, lower blood pressure, more severe functional class, renal insufficiency, and recent HF hospitalization generally favored lower medication utilization or dose. Social and economic characteristics were not independently associated with medication use or dose.

Conclusions: In this contemporary outpatient HFrEF registry, significant gaps in use and dose of guideline-directed medical therapy remain. Multiple clinical factors were associated with medication use and dose prescribed. Strategies to improve guideline-directed use of HFrEF medications remain urgently needed, and these findings may inform targeted approaches to optimize outpatient medical therapy.

Keywords: dose; medication; reduced ejection fraction; registry.

MeSH terms

  • Adrenergic beta-Antagonists* / administration & dosage
  • Adrenergic beta-Antagonists* / therapeutic use
  • Age Factors
  • Aged
  • Angiotensin Receptor Antagonists* / administration & dosage
  • Angiotensin Receptor Antagonists* / therapeutic use
  • Dose-Response Relationship, Drug*
  • Drug Utilization / statistics & numerical data*
  • Female
  • Heart Failure* / drug therapy
  • Heart Failure* / epidemiology
  • Heart Failure* / physiopathology
  • Humans
  • Male
  • Middle Aged
  • Mineralocorticoid Receptor Antagonists* / administration & dosage
  • Mineralocorticoid Receptor Antagonists* / therapeutic use
  • Practice Guidelines as Topic
  • Quality Improvement
  • Registries / statistics & numerical data
  • Severity of Illness Index
  • Socioeconomic Factors
  • Stroke Volume
  • United States / epidemiology


  • Adrenergic beta-Antagonists
  • Angiotensin Receptor Antagonists
  • Mineralocorticoid Receptor Antagonists