Hung-Yu Chang1, Chun-Chieh Wang2, Jeng Wei3, Chong-Yi Chang3, Yi-Cheng Chuang3, Chien-Long Huang3, Eric Chong4, Jiunn-Lee Lin5, Guang-Yuan Mar6, Kuei-Chuan Chan7, Jen-Yuan Kuo8, Ji-Hung Wang9, Zhih-Cherng Chen10, Wei-Kung Tseng11, Wen-Jin Cherng12, Wei-Hsian Yin13. 1. Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC. 2. Division of Cardiology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, ROC. 3. Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC. 4. Division of Cardiology, Jurong Health Pte Ltd, Singapore. 5. Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan, ROC. 6. Division of Cardiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC. 7. Department of Internal Medicine, Chung-Shan Medical University Hospital, Taichung, Taiwan, ROC. 8. Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan, ROC. 9. Division of Cardiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan, ROC. 10. Division of Cardiovascular Medicine, Chimei Medical Center, Tainan, Taiwan, ROC. 11. Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan, ROC. 12. Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan, ROC. 13. Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC. Electronic address: yinwh88@gmail.com.
Abstract
BACKGROUND: Heart failure (HF) is a global health problem. Guidelines for the management of HF have been established in Western countries and in Taiwan. However, data from the Taiwan Society of Cardiology-Heart Failure with reduced Ejection Fraction (TSOC-HFrEF) registry showed suboptimal prescription of guideline-recommended medications. We aimed to analyze the reason of non-prescription and clinical outcomes as a result of under-prescription of medications. METHODS: A total of 1509 patients hospitalized for acute HFrEF were recruited in 21 hospitals in Taiwan by the end of October 2014. Prescribed guideline-recommended medications and other relevant clinical parameters were collected and analyzed at discharge and 1 year after index hospitalization. RESULTS: At discharge, 62% of patients were prescribed with either angiotensin-converting enzyme-inhibitors (ACEI) or angiotensin receptor blockers (ARB); 60% were prescribed with beta-blockers and 49% were prescribed with mineralocorticoid receptor antagonists (MRA). The proportions of patients at ≥50% of the target dose for ACEI/ARB, beta-blockers and MRA were 24.4%, 20.6%, 86.2%, respectively. At 1-year follow-up, dosages of ACEI/ARB and MRA were up-titrated in about one-fourth patients, and dosages of beta-blocker were up-titrated in about 40% patients. One-year mortality rate was lowest in patients who received at least 2 classes of guideline-recommended medications with ≥50% of the target dose, and highest in those who received 0 or 1 class of medications. CONCLUSION: The TSOC-HFrEF registry demonstrated the under-prescription of guideline-recommended medications and reluctance of physicians to up-titrate medications to target dose. Action plan needs be formulated in order to improve physician's adherence to HF guidelines.
BACKGROUND:Heart failure (HF) is a global health problem. Guidelines for the management of HF have been established in Western countries and in Taiwan. However, data from the Taiwan Society of Cardiology-Heart Failure with reduced Ejection Fraction (TSOC-HFrEF) registry showed suboptimal prescription of guideline-recommended medications. We aimed to analyze the reason of non-prescription and clinical outcomes as a result of under-prescription of medications. METHODS: A total of 1509 patients hospitalized for acute HFrEF were recruited in 21 hospitals in Taiwan by the end of October 2014. Prescribed guideline-recommended medications and other relevant clinical parameters were collected and analyzed at discharge and 1 year after index hospitalization. RESULTS: At discharge, 62% of patients were prescribed with either angiotensin-converting enzyme-inhibitors (ACEI) or angiotensin receptor blockers (ARB); 60% were prescribed with beta-blockers and 49% were prescribed with mineralocorticoid receptor antagonists (MRA). The proportions of patients at ≥50% of the target dose for ACEI/ARB, beta-blockers and MRA were 24.4%, 20.6%, 86.2%, respectively. At 1-year follow-up, dosages of ACEI/ARB and MRA were up-titrated in about one-fourth patients, and dosages of beta-blocker were up-titrated in about 40% patients. One-year mortality rate was lowest in patients who received at least 2 classes of guideline-recommended medications with ≥50% of the target dose, and highest in those who received 0 or 1 class of medications. CONCLUSION: The TSOC-HFrEF registry demonstrated the under-prescription of guideline-recommended medications and reluctance of physicians to up-titrate medications to target dose. Action plan needs be formulated in order to improve physician's adherence to HF guidelines.
Authors: Rafał Niemiec; Irmina Morawska; Maria Stec; Wiktoria Kuczmik; Andrzej S Swinarew; Arkadiusz Stanula; Katarzyna Mizia-Stec Journal: Int J Environ Res Public Health Date: 2022-02-13 Impact factor: 3.390
Authors: Larry A Allen; Grace Venechuk; Colleen K McIlvennan; Robert L Page; Christopher E Knoepke; Laura J Helmkamp; Prateeti Khazanie; Pamela N Peterson; Kenneth Pierce; Geoffrey Harger; Jocelyn S Thompson; Tristan J Dow; Lance Richards; Janice Huang; James R Strader; Katy E Trinkley; David P Kao; David J Magid; Peter M Buttrick; Daniel D Matlock Journal: Circulation Date: 2020-11-17 Impact factor: 29.690