April 20, 2016European Journal of Heart Failure251 citationsOpen Access
Physicians’ Adherence to Guideline-Recommended Medications in Heart Failure with Reduced Ejection Fraction: Data from the QUALIFY Global Survey
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Resultado clave
Physicians' adherence to guideline-recommended medications for heart failure was good in 67% of patients, but the proportion of patients at target doses was low (e.g., 27.9% for ACEIs).
Diseño del estudio
Tipo
Observational (n=7,092)
Multicéntrico
Sí
PICO estructurado
P
Población
7,092 chronic heart failure (CHF) outpatients with reduced ejection fraction recruited 1-15 months after hospitalization for heart failure, multinational (36 countries)
I
Intervención
Guideline-recommended medications (ACE inhibitors, beta-blockers, angiotensin receptor blockers, mineralocorticoid receptor antagonists, and ivabradine)
O
Resultado
Physicians' adherence to guideline-recommended medications assessed via a five-class guideline adherence score
While general adherence to prescribing guideline-recommended heart failure medications is relatively good, the achievement of target doses remains globally suboptimal.
Resumen
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 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.