BACKGROUND: The effectiveness of chronic heart failure (CHF) pharmacotherapy in unselected cohorts is unknown. AIMS: To estimate the association between quality of CHF pharmacotherapy and all-cause mortality risk. METHODS AND RESULTS: In a prospective cohort study, 1054 unselected patients with CHF (61% with reduced and 39% with normal left ventricular ejection fraction (LVEF)) were consecutively enrolled. Quality of pharmacotherapy was assessed by calculating a guideline adherence indicator (GAI-3, range 0-100%) based on prescription of beta blockers, angiotensin converting enzyme inhibitors or angiotensin receptor II type-1 blockers, and mineralocorticoid receptor antagonists. Median follow-up in survivors was 595 days (100% complete). In patients with reduced LVEF the median GAI-3 was 67%, and inversely associated with age, CHF severity, and important comorbidities. Mortality rates in GAI-3 categories low/medium/high were 79/30/11 per 100 person-years. In multivariable Cox regression, high GAI-3 was independently predictive of lower mortality risk: hazard ratio (HR) 0.50 (95% confidence interval [CI] 0.32-0.74; P<0.001) vs low GAI-3. This association was also observed in subgroups of high age (HR 0.42, 95%CI 0.27-0.66; P<0.001) and women (HR 0.42, 95%CI 0.23-0.79; P=0.007). CONCLUSIONS: In this community-based cohort with CHF, better implementation of pharmacotherapy was associated with better prognosis in patients with reduced LVEF, irrespective of age and sex.
BACKGROUND: The effectiveness of chronic heart failure (CHF) pharmacotherapy in unselected cohorts is unknown. AIMS: To estimate the association between quality of CHF pharmacotherapy and all-cause mortality risk. METHODS AND RESULTS: In a prospective cohort study, 1054 unselected patients with CHF (61% with reduced and 39% with normal left ventricular ejection fraction (LVEF)) were consecutively enrolled. Quality of pharmacotherapy was assessed by calculating a guideline adherence indicator (GAI-3, range 0-100%) based on prescription of beta blockers, angiotensin converting enzyme inhibitors or angiotensin receptor II type-1 blockers, and mineralocorticoid receptor antagonists. Median follow-up in survivors was 595 days (100% complete). In patients with reduced LVEF the median GAI-3 was 67%, and inversely associated with age, CHF severity, and important comorbidities. Mortality rates in GAI-3 categories low/medium/high were 79/30/11 per 100 person-years. In multivariable Cox regression, high GAI-3 was independently predictive of lower mortality risk: hazard ratio (HR) 0.50 (95% confidence interval [CI] 0.32-0.74; P<0.001) vs low GAI-3. This association was also observed in subgroups of high age (HR 0.42, 95%CI 0.27-0.66; P<0.001) and women (HR 0.42, 95%CI 0.23-0.79; P=0.007). CONCLUSIONS: In this community-based cohort with CHF, better implementation of pharmacotherapy was associated with better prognosis in patients with reduced LVEF, irrespective of age and sex.
Authors: C Zugck; J Franke; G Gelbrich; L Frankenstein; T Scheffold; S Pankuweit; H D Duengen; V Regitz-Zagrosek; B Pieske; T Neumann; M Rauchhaus; C E Angermann; H A Katus; G E Ertl; S Störk Journal: Clin Res Cardiol Date: 2011-12-03 Impact factor: 5.460
Authors: Jennifer Franke; Jan Sebastian Wolter; Lillian Meme; Jeannette Keppler; Ramon Tschierschke; Hugo A Katus; Christian Zugck Journal: Clin Res Cardiol Date: 2012-07-04 Impact factor: 5.460
Authors: Ken Lee Chin; Marina Skiba; Andrew Tonkin; Christopher M Reid; Danny Liew; Henry Krum; Ingrid Hopper Journal: Heart Fail Rev Date: 2016-11 Impact factor: 4.214
Authors: Marc N Hirt; Aljosha Muttardi; Thomas M Helms; Hendrik van den Bussche; Thomas Eschenhagen Journal: Clin Res Cardiol Date: 2015-11-09 Impact factor: 5.460