G Poelzl1, J Altenberger2, R Pacher3, C H Ebner4, M Wieser5, A Winter6, F Fruhwald7, C Dornaus8, U Ehmsen9, S Reiter10, R Steinacher11, M Huelsmann3, V Eder4, A Boehmer5, L Pilgersdorfer6, K Ablasser7, D Keroe9, H Groebner12, J Auer13, G Jakl14, A Hallas15, M Ess1, H Ulmer16. 1. Clinical Division of Cardiology, Innsbruck Medical University, Austria. 2. Department of Cardiology, Paracelsus Medical University Salzburg, Austria; Center for Cardiac Rehabilitation, Pensionsversicherungsanstalt, Grossgmain, Austria. 3. Clinical Division of Cardiology, Vienna Medical University, Austria. 4. Department of Cardiology, St. Elisabeth Hospital, Linz, Austria. 5. Department of Cardiology, Krems General Hospital, Austria. 6. Department of Cardiology, Hospital of the Sisters of Charity, Linz, Austria. 7. Department of Cardiology, Graz Medical University, Austria. 8. 2nd Department of Medicine, Hanusch Hospital, Vienna, Austria. 9. Private practice, Vienna, Austria. 10. Department of Cardiology, Kaiser Franz Josef Hospital, Vienna, Austria. 11. Department of Cardiology, Paracelsus Medical University Salzburg, Austria. 12. Department of Internal Medicine, St. Johann County Hospital, Austria. 13. Department of Cardiology and Intensive Care, Braunau General Hospital, Austria. 14. 3rd Department of Medicine, Wilhelminenspital, Vienna, Austria. 15. Department of Internal Medicine and Cardiology, Donauklinikum Tulln, Austria. 16. Department of Medical Statistics, Informatics and Health Economics, Innsbruck Medical University, Austria.
Abstract
AIMS: Guidelines have been published for improving management of chronic heart failure (CHF). We examined the association between improved guideline adherence and risk for all-cause death in patients with stable systolic HF. METHODS: Data on ambulatory patients (2006-2010) with CHF and reduced ejection fraction (HF-REF) from the Austrian Heart Failure Registry (HIR Austria) were analysed. One-year clinical data and long-term follow-up data until all-cause death or data censoring were available for 1014 patients (age 65 [55-73], male 75%, NYHA class I 14%, NYHA II 56%, NYHA III/IV 30%). A guideline adherence indicator (GAI [0-100%]) was calculated for each patient at baseline and after 12 ± 3 months that considered indications and contraindications for ACE-I/ARB, beta blockers, and MRA. Patients were considered ΔGAI-positive if GAI improved to or remained at high levels (≥ 80%). ΔGAI50+ positivity was ascribed to patients achieving a dose of ≥ 50% of suggested target dose. RESULTS: Improvements in GAI and GAI50+ were associated with significant improvements in NYHA class and NT-proBNP (1728 [740-3636] to 970 [405-2348]) (p<0.001). Improvements in GAI50+, but not GAI, were independently predictive of lower mortality risk (HR 0.55 [95% CI 0.34-0.87; p=0.01]) after adjustment for a large variety of baseline parameters and hospitalisation for heart failure during follow-up. CONCLUSIONS: Improvement in guideline adherence with particular emphasis on dose escalation is associated with a decrease in long-term mortality in ambulatory HF-REF subjects surviving one year after registration.
AIMS: Guidelines have been published for improving management of chronic heart failure (CHF). We examined the association between improved guideline adherence and risk for all-cause death in patients with stable systolic HF. METHODS: Data on ambulatory patients (2006-2010) with CHF and reduced ejection fraction (HF-REF) from the Austrian Heart Failure Registry (HIR Austria) were analysed. One-year clinical data and long-term follow-up data until all-cause death or data censoring were available for 1014 patients (age 65 [55-73], male 75%, NYHA class I 14%, NYHA II 56%, NYHA III/IV 30%). A guideline adherence indicator (GAI [0-100%]) was calculated for each patient at baseline and after 12 ± 3 months that considered indications and contraindications for ACE-I/ARB, beta blockers, and MRA. Patients were considered ΔGAI-positive if GAI improved to or remained at high levels (≥ 80%). ΔGAI50+ positivity was ascribed to patients achieving a dose of ≥ 50% of suggested target dose. RESULTS: Improvements in GAI and GAI50+ were associated with significant improvements in NYHA class and NT-proBNP (1728 [740-3636] to 970 [405-2348]) (p<0.001). Improvements in GAI50+, but not GAI, were independently predictive of lower mortality risk (HR 0.55 [95% CI 0.34-0.87; p=0.01]) after adjustment for a large variety of baseline parameters and hospitalisation for heart failure during follow-up. CONCLUSIONS: Improvement in guideline adherence with particular emphasis on dose escalation is associated with a decrease in long-term mortality in ambulatory HF-REF subjects surviving one year after registration.
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
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Authors: Caroline Morbach; Martin Wagner; Stefan Güntner; Carolin Malsch; Mehmet Oezkur; David Wood; Kornelia Kotseva; Rainer Leyh; Georg Ertl; Wolfgang Karmann; Peter U Heuschmann; Stefan Störk Journal: BMC Cardiovasc Disord Date: 2017-05-05 Impact factor: 2.298
Authors: Tayler A Buchan; Crizza Ching; Farid Foroutan; Abdullah Malik; Julian F Daza; Nicholas Ng Fat Hing; Reed Siemieniuk; Nathan Evaniew; Ani Orchanian-Cheff; Heather J Ross; Gordon Guyatt; Ana C Alba Journal: Heart Fail Rev Date: 2021-07-05 Impact factor: 4.214