Michel Komajda1, Stefan D Anker2, Martin R Cowie3, Gerasimos S Filippatos4, Bastian Mengelle5, Piotr Ponikowski6, Luigi Tavazzi7. 1. Institute of Cardiometabolism and Nutrition (ICAN), Pierre & Marie Curie Paris VI University, La Pitié-Salpétrière Hospital, AP-HP, 47-83 Boulevard de l'Hôpital, 75013, Paris, France. 2. Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Centre Göttingen (UMG), Göttingen, Germany. 3. Imperial College London, Royal Brompton Hospital, London, UK. 4. Athens University Hospital Attikon, Athens, Greece. 5. Department of Biometry, Lincoln, Boulogne-Billancourt, France. 6. Medical University, Faculty of Public Health, Wroclaw, Poland. 7. Maria Cecilia Hospital, GVM Care & Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy.
Abstract
AIMS: To assess physicians' adherence to guideline-recommended medications for the treatment of chronic heart failure (CHF) with reduced ejection fraction. METHODS AND RESULTS: QUALIFY is an international prospective observational longitudinal survey of 7092 CHF outpatients recruited 1-15 months after hospitalization for heart failure from September 2013 to December 2014 in 547 centres in 36 countries. We constructed a five-class guideline adherence score for angiotensin converting enzyme inhibitors (ACEIs), beta-blockers, angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists, and ivabradine. The adherence score was good in 67%, moderate in 25%, and poor in 8% of patients. Adherence was lower in women than men but there were differences in age (65.7 ± 12.5 years women vs. 62.2 ± 12.4 years men, P < 0.001) and the proportion of women at ≥50% target dose of beta-blockers was lower in those >67 years (median) (11% vs. 16.2%, P = 0.005). Geographic variations were observed with lower adherence scores in Central/Eastern European countries. The proportion of patients at target dose and ≥50% of target dose was low (27.9% and 63.3% for ACEIs, 14.8% and 51.8% for beta-blockers, 6.9% and 39.5% for ARBs, and 6.9% and 39.5% for ivabradine, respectively). It was also lower in patients most recently hospitalized (<6 vs. ≥6 months) except for beta-blockers. CONCLUSION: This international survey shows that adherence to guideline-recommended medications is relatively satisfactory but the dosage of recommended CHF medications is usually suboptimal. Action plans aimed at improving adherence to guidelines are required.
AIMS: To assess physicians' adherence to guideline-recommended medications for the treatment of chronic heart failure (CHF) with reduced ejection fraction. METHODS AND RESULTS: QUALIFY is an international prospective observational longitudinal survey of 7092 CHF outpatients recruited 1-15 months after hospitalization for heart failure from September 2013 to December 2014 in 547 centres in 36 countries. We constructed a five-class guideline adherence score for angiotensin converting enzyme inhibitors (ACEIs), beta-blockers, angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists, and ivabradine. The adherence score was good in 67%, moderate in 25%, and poor in 8% of patients. Adherence was lower in women than men but there were differences in age (65.7 ± 12.5 years women vs. 62.2 ± 12.4 years men, P < 0.001) and the proportion of women at ≥50% target dose of beta-blockers was lower in those >67 years (median) (11% vs. 16.2%, P = 0.005). Geographic variations were observed with lower adherence scores in Central/Eastern European countries. The proportion of patients at target dose and ≥50% of target dose was low (27.9% and 63.3% for ACEIs, 14.8% and 51.8% for beta-blockers, 6.9% and 39.5% for ARBs, and 6.9% and 39.5% for ivabradine, respectively). It was also lower in patients most recently hospitalized (<6 vs. ≥6 months) except for beta-blockers. CONCLUSION: This international survey shows that adherence to guideline-recommended medications is relatively satisfactory but the dosage of recommended CHF medications is usually suboptimal. Action plans aimed at improving adherence to guidelines are required.
Authors: Catherine N Marti; Gregg C Fonarow; Stefan D Anker; Clyde Yancy; Muthiah Vaduganathan; Stephen J Greene; Ali Ahmed; James L Januzzi; Mihai Gheorghiade; Gerasimos Filippatos; Javed Butler Journal: Eur J Heart Fail Date: 2018-12-10 Impact factor: 15.534
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