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).
Observational (n=7,092)
Yes
While general adherence to prescribing guideline-recommended heart failure medications is relatively good, the achievement of target doses remains globally suboptimal.
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.
Komajda et al. (2016) conducted an observational in chronic heart failure (CHF) with reduced ejection fraction (n=7,092). Guideline-recommended medications was evaluated on five-class guideline adherence score for ACEIs, beta-blockers, ARBs, mineralocorticoid receptor antagonists, and ivabradine. 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).