NEW YORK (Reuters Health) – Despite numerous advances in treatment, evidence-based outpatient therapy for congestive heart failure (CHF) has not improved since 2002, researchers report in the August 9/23 Archives of Internal Medicine.

“Over time, there can be a drop off in recommended care for any condition, since the initial sheen of a novel therapy wears off, and the recommended medications become generic and less heavily promoted,” Dr. Dipanjan Banerjee told Reuters Health in an email. “We need to create systems, both personal and organizational, which ensure that the use of a recommended therapy remains high long after that therapy has been proven to improve outcomes for our patients.”

Dr. Banerjee and Dr. Randall S. Stafford, both from Stanford University School of Medicine, California, used nationally representative data from the National Disease and Therapeutic Index physician survey produced by IMS Health to evaluate patterns of medication use since 1994.

Angiotensin blocking therapies increased gradually from 34% of outpatient visits for CHF in 1994 to 45% in 2002. Thereafter, however, there has been a steady decline, to 32% in 2009.

There was a similar pattern for beta-blocker use, with a rise from 11% of visits in 1998 to a peak of 44% in 2006, followed by a decline to 37% by 2009.

Aldosterone antagonist use in CHF increased from 1% in 1998 to 11% in 2003 and has fluctuated between 8% and 12% since 2003.

There have been also been substantial declines in the use of digoxin (since 1997) and a gradual downward trend in the use of diuretics (since 1994).

The investigators say the trend since the mid-2000s is troubling. “The current framework used to promulgate evidence-based therapy for CHF does not appear to be sufficient to facilitate appropriate levels of therapy.”

Steps have already been taken to improve the inpatient management of CHF, Dr. Banerjee noted. “I feel the most important step that could be taken to improve CHF care at this time would be to create outpatient management schema focusing upon recommended therapy for CHF (similar to the ‘core measures’ initiative used for inpatients), or to enhance and expand existing schema (such as nurse coordinated outpatient CHF management algorithms).”

Arch Intern Med 2010;170:1399-1400.