Treatment gaps in the pharmacologic management of heart failure

Chronic heart failure continues to increase in incidence and prevalence despite many pharmacologic advances over the previous decade. Morbidity and mortality remain high, with the number of hospitalizations for worsening heart failure in 1999 approaching 1 million. In addition to investigation of new therapies for the treatment of heart failure, attention must be placed on identifying effective methods for increasing the adoption of proven therapies. First, the potential barriers to implementation of evidence-based medicine must be recognized. Subsequently, strategies to overcome such barriers can be developed. Published guidelines may be helpful in educating practitioners on current standards of care. Other tools may also be considered, and testing the influence of such tools on the implementation of optimal therapy may help the scientific community better understand the factors that influence decision-making among clinicians.