August 30, 2005BMC Health Services ResearchOpen Access

Heart failure guidelines and prescribing in primary care across Europe

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Chronic heart failure (n=11062). Intervention: National heart failure guideline recommendations vs. Differing or absent national guideline recommendations. Primary outcome: Prescribing of ACE inhibitors combined with spironolactone (OR 0.74, 95% CI 0.63-0.87).

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Key result

Differences in national heart failure guideline recommendations were insufficient to explain international prescribing variations, showing inconsistent relationships such as decreased spironolactone use with warnings (OR 0.74) but paradoxically lower beta-blocker use when indications were unrestricted (OR 0.69).

Study Design

Type

Cross-Sectional (n=11,062)

Multicenter

Yes

Structured PICO

Population

11,062 primary care patients with chronic heart failure across 14 European countries, evaluated to assess the relationship between national guideline recommendations and actual prescribing patterns.

Exposure

National heart failure guideline recommendations

Comparator

European Society of Cardiology (ESC) 1997 guideline recommendations

Outcome

Variation in guideline recommendations and their association with national prescribing patterns

Main Result

Odds Ratio: 0.74 (95% CI 0.63–0.87)

Absolute Event Rate: 5.7% vs 7.2%

Differences in national guideline recommendations do not sufficiently explain the wide international variation in heart failure prescribing patterns in primary care.

Limitations

Focused on published content rather than the rigor of guideline development
Did not use a formal guideline appraisal instrument
In-depth analysis was limited to major drug groups
Cross-sectional analysis could not account for differences in time of guideline publication and emergence of new evidence
Published national guidelines might not reflect the recommendations actually used by physicians
Lacked detailed information about the guideline implementation process
Variations in physician characteristics and national organization of care were present
In depth analysis of recommendations was limited to major drug groups and therefore minor differences might not have been considered.

Discussion

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Implication

Guideline differences do not explain HF prescribing variation; leaves open implementation, patient, and system factors for targeted research.

Cite This Study

Sturm et al. (2005) conducted a cross-sectional in Chronic heart failure (n=11,062). National heart failure guideline recommendations vs. Differing or absent national guideline recommendations was evaluated on Prescribing of ACE inhibitors combined with spironolactone (OR 0.74, 95% CI 0.63-0.87). Differences in national heart failure guideline recommendations were insufficient to explain international prescribing variations, showing inconsistent relationships such as decreased spironolactone use with warnings (OR 0.74) but paradoxically lower beta-blocker use when indications were unrestricted (OR 0.69).

synapsesocial.com/papers/6a932aa905a97cecfb6dc61e https://doi.org/10.1186/1472-6963-5-57

Topics

Heart failure HFrEF treatment

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Implication

Guideline differences do not explain HF prescribing variation; leaves open implementation, patient, and system factors for targeted research.

Heart failure guidelines and prescribing in primary care across Europe

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Topics

Heart failure guidelines and prescribing in primary care across Europe

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Topics

Also Consider