BACKGROUND: There is robust evidence for effective pharmacotherapy of chronic (systolic) heart failure (CHF) which has led to the creation of guidelines, but many surveys evaluating CHF treatment show an under-utilisation of relevant drugs, while setting and patient population appear to be crucial for adequate appraisal of treatment patterns. AIMS: To evaluate the guideline adherence (GA) of general practitioners (GPs) in a well-defined patient population with CHF in primary care (PC). METHODS: A cross-sectional analysis was performed with the data of 167 patients enrolled in 37 GP practices (Germany) with documented left ventricular systolic dysfunction (LVEF: 33.3 +/- 6.9%). GA was assessed as usual (prescribing "yes" or "no"), through evaluation of target dosing, while adjusting for potential clinical contraindications, and through a modified Guideline Adherence Indicator-3 (mGAI-3), which assesses three relevant groups of substances according to New York Heart Association (NYHA) functional class: ACE-Inhibitors (ACE-I) or angiotensin receptor blockers (ARB), beta-blockers (BB) and aldosterone-antagonists (AA). RESULTS: Prescription rates for ACE-I/ARB, BB or both were 80%, 75% and 62%, respectively. The proportion of target doses reached for ACE-I was 16%, for BB only 8%. When adjusted for potential (mainly relative) contraindications (COPD, heart rate <60/min, hypotension, hyperkalaemia and renal dysfunction), the percentage of target doses reached increased to 49% for ACE-I/ARBs and 46% for BB. Application of the mGAI-3 showed moderate to perfect GA for usual assessment, proportion of target dose reached and adjusted in 83%, 16% and 55% of the patients, respectively. CONCLUSION: In the context of this patient and doctor setting, life-saving treatment was provided above average when assessed by usual criteria. The application of additional criteria showed further room for improvement. Future interventions aiming at optimisation should be tailored to the needs of doctors and patients likewise.
BACKGROUND: There is robust evidence for effective pharmacotherapy of chronic (systolic) heart failure (CHF) which has led to the creation of guidelines, but many surveys evaluating CHF treatment show an under-utilisation of relevant drugs, while setting and patient population appear to be crucial for adequate appraisal of treatment patterns. AIMS: To evaluate the guideline adherence (GA) of general practitioners (GPs) in a well-defined patient population with CHF in primary care (PC). METHODS: A cross-sectional analysis was performed with the data of 167 patients enrolled in 37 GP practices (Germany) with documented left ventricular systolic dysfunction (LVEF: 33.3 +/- 6.9%). GA was assessed as usual (prescribing "yes" or "no"), through evaluation of target dosing, while adjusting for potential clinical contraindications, and through a modified Guideline Adherence Indicator-3 (mGAI-3), which assesses three relevant groups of substances according to New York Heart Association (NYHA) functional class: ACE-Inhibitors (ACE-I) or angiotensin receptor blockers (ARB), beta-blockers (BB) and aldosterone-antagonists (AA). RESULTS: Prescription rates for ACE-I/ARB, BB or both were 80%, 75% and 62%, respectively. The proportion of target doses reached for ACE-I was 16%, for BB only 8%. When adjusted for potential (mainly relative) contraindications (COPD, heart rate <60/min, hypotension, hyperkalaemia and renal dysfunction), the percentage of target doses reached increased to 49% for ACE-I/ARBs and 46% for BB. Application of the mGAI-3 showed moderate to perfect GA for usual assessment, proportion of target dose reached and adjusted in 83%, 16% and 55% of the patients, respectively. CONCLUSION: In the context of this patient and doctor setting, life-saving treatment was provided above average when assessed by usual criteria. The application of additional criteria showed further room for improvement. Future interventions aiming at optimisation should be tailored to the needs of doctors and patients likewise.
Authors: Scot H Simpson; Dean T Eurich; Sumit R Majumdar; Rajdeep S Padwal; Ross T Tsuyuki; Janice Varney; Jeffrey A Johnson Journal: BMJ Date: 2006-06-21
Authors: Michel Komajda; Pablo Lapuerta; Nancy Hermans; José Ramon Gonzalez-Juanatey; Dirk J van Veldhuisen; Erland Erdmann; Luigi Tavazzi; Philip Poole-Wilson; Claude Le Pen Journal: Eur Heart J Date: 2005-04-12 Impact factor: 29.983
Authors: J G F Cleland; K Swedberg; F Follath; M Komajda; A Cohen-Solal; J C Aguilar; R Dietz; A Gavazzi; R Hobbs; J Korewicki; H C Madeira; V S Moiseyev; I Preda; W H van Gilst; J Widimsky; N Freemantle; Joanne Eastaugh; J Mason Journal: Eur Heart J Date: 2003-03 Impact factor: 29.983
Authors: Ashvarya Mangla; Rami Doukky; DeJuran Richardson; Elizabeth F Avery; Rebecca Dawar; James E Calvin; Lynda H Powell Journal: Am Heart J Date: 2017-09-29 Impact factor: 4.749
Authors: Frank Peters-Klimm; Stephen Campbell; Katja Hermann; Cornelia U Kunz; Thomas Müller-Tasch; Joachim Szecsenyi Journal: Trials Date: 2010-05-17 Impact factor: 2.279
Authors: Frank Peters-Klimm; Stephen Campbell; Thomas Müller-Tasch; Dieter Schellberg; Goetz Gelbrich; Wolfgang Herzog; Joachim Szecsenyi Journal: Trials Date: 2009-08-13 Impact factor: 2.279