Key result
High adherence to heart failure pharmacotherapy guidelines was associated with a lower risk of all-cause mortality compared to low adherence (HR 0.50; 95% CI 0.32-0.74; P<0.001).
Why the study?
Does high guideline adherence for pharmacotherapy reduce all-cause mortality in patients with chronic heart failure?
Cohort (n=1,054)
Does high guideline adherence for pharmacotherapy reduce all-cause mortality in patients with chronic heart failure?
Better implementation of guideline-directed pharmacotherapy is associated with significantly lower mortality in patients with reduced LVEF chronic heart failure.
Supports quality improvement for guideline-directed HF therapy; leaves open causal confirmation from randomized implementation trials.
BACKGROUND: The effectiveness of chronic heart failure (CHF) pharmacotherapy in unselected cohorts is unknown. AIMS: To estimate the association between quality of CHF pharmacotherapy and all-cause mortality risk. METHODS AND RESULTS: In a prospective cohort study, 1054 unselected patients with CHF (61% with reduced and 39% with normal left ventricular ejection fraction (LVEF)) were consecutively enrolled. Quality of pharmacotherapy was assessed by calculating a guideline adherence indicator (GAI-3, range 0-100%) based on prescription of beta blockers, angiotensin converting enzyme inhibitors or angiotensin receptor II type-1 blockers, and mineralocorticoid receptor antagonists. Median follow-up in survivors was 595 days (100% complete). In patients with reduced LVEF the median GAI-3 was 67%, and inversely associated with age, CHF severity, and important comorbidities. Mortality rates in GAI-3 categories low/medium/high were 79/30/11 per 100 person-years. In multivariable Cox regression, high GAI-3 was independently predictive of lower mortality risk: hazard ratio (HR) 0.50 (95% confidence interval [CI] 0.32-0.74; P<0.001) vs low GAI-3. This association was also observed in subgroups of high age (HR 0.42, 95%CI 0.27-0.66; P<0.001) and women (HR 0.42, 95%CI 0.23-0.79; P=0.007). CONCLUSIONS: In this community-based cohort with CHF, better implementation of pharmacotherapy was associated with better prognosis in patients with reduced LVEF, irrespective of age and sex.
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Störk et al. (2008) conducted a cohort in chronic heart failure (CHF) (n=1,054). High guideline adherence indicator (GAI-3) for pharmacotherapy vs. Low guideline adherence indicator (GAI-3) was evaluated on all-cause mortality (HR 0.50, 95% CI 0.32-0.74, p=<0.001). High adherence to heart failure pharmacotherapy guidelines was associated with a lower risk of all-cause mortality compared to low adherence (HR 0.50; 95% CI 0.32-0.74; P<0.001).
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