Doctors Often Ignore Recommended Heart Failure Drug

The big challenge in health care isn't always finding a new cure but instead getting doctors to use the ones already out there.

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Take, for instance, a generic drug to help patients with serious heart failure. Despite advice issued by two leading professional societies for heart doctors in 2005, two years later less than a third of hospitalized heart failure patients who could benefit from drugs called aldosterone antagonists were on them when leaving the hospital. In Europe, about half of such patients are taking the drugs at discharge.

The findings, published in the current issue of JAMA, underscore the continuing challenge of getting doctors to incorporate evidence-based treatments into everyday practice.

How come it's so hard? In the case of aldosterone antagonists, one problem, believe it or not, is an absence of drug company marketing. Spironolactone, the aldosterone-blocking workhorse, is generic, so drugmakers aren't beating down doctors doors or advertising the medicine to patients.

Cleveland Clinic researcher Nancy Albert, who led the work, told us doctors may be thinking harder about using other medicines, including beta blockers, first. Unfamiliarity with the guideline, including a beefed-up revision, and a lack of comfort with the medicines for some patients are other reasons she cited for the slow adoption of aldosterone antagonists.

She hopes the paper will spur awareness and perhaps get use of the drugs for heart failure added to a set of quality measures that hospitals are judged on for accreditation. In the meantime, individual hospitals may take it upon themselves to do more.