Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey
Key result
High guideline adherence linked to ~46% fewer cardiovascular hospitalizations in heart failure.
- P<0.001
- n=1,410
Why the study?
The impact of adherence to European guidelines for the treatment of chronic heart failure on patient outcomes had not been evaluated.
Does adherence to treatment guidelines reduce CHF and CV hospitalizations in patients with chronic heart failure?
Population
1410 patients with chronic heart failure from six European countries
Comparison
Higher versus lower adherence to European treatment guidelines
Design
Observational study with adherence indicators
Follow-up
6 months
Authors
Discussion
Loading...
Member takes
Implication
Supports guideline adherence in chronic HF; leaves open causality pending randomized trials.
Key Points
- To assess how cardiologist adherence to European treatment guidelines affects chronic heart failure and cardiovascular hospitalization rates and time to hospitalization.
- Followed 1,410 chronic heart failure patients across six European countries for 6 months under the care of 150 randomly selected cardiologists.
- Formulated class adherence indicators for five drug classes and global adherence indicators evaluating three (GAI3) and five (GAI5) guideline-recommended medications.
- Overall guideline adherence was 60% for GAI3 and 63% for GAI5, with higher adherence for ACE-inhibitors (88%) and diuretics (82%) than spironolactone (36%).
- Decreasing adherence tertiles significantly correlated with increased rates of heart failure hospitalization (6.7% vs. 9.7% vs. 14.7%, P < 0.002) and cardiovascular hospitalization (11.2% vs. 15.9% vs. 20.6%, P < 0.001).
- Global adherence indicator GAI3 independently predicted time to cardiovascular hospitalization in multivariable modeling alongside NYHA class and vascular comorbidities.
Study Design
Type
Observational (n=1,410)
Multicenter
Yes
Structured PICO
Does adherence to treatment guidelines reduce CHF and CV hospitalizations in patients with chronic heart failure?
P
Population
1,410 patients with chronic heart failure (mean age 69, 69% males, NYHA II: 64%, III: 34%, IV: 2%) from six European countries.
I
Intervention
High adherence to European guidelines for the treatment of chronic heart failure (measured by GAI3 and GAI5 adherence indicators)
C
Comparator
Lower adherence to guidelines (evaluated across tertiles of adherence scores)
O
Outcome
Rate of CHF and cardiovascular (CV) hospitalizations and time to CV hospitalization at 6 monthshard clinical
Main Result
Absolute Event Rate: 11.2% vs 20.6%
p-value: p=<0.001
Higher physician adherence to heart failure treatment guidelines is associated with significantly lower rates of cardiovascular and heart failure hospitalizations.
Cite This Study
Komajda et al. (2005) conducted an observational in Chronic heart failure (n=1,410). Adherence to treatment guidelines vs. Lower adherence to treatment guidelines was evaluated on Cardiovascular hospitalization (p=<0.001). Physician adherence to heart failure treatment guidelines was associated with significantly lower rates of cardiovascular hospitalization across adherence tertiles (11.2% vs 15.9% vs 20.6%, P<0.001).