6533b7d5fe1ef96bd1265169
RESEARCH PRODUCT
Physicians' guideline adherence is associated with long-term heart failure mortality in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry.
Ingrid HopperVasilica EnacheArintaya PhrommintikulLars KoberOlga KoshelskayaAsri SaidJuan Francisco Delgado JiménezRuslan AbdullayevJonathan HowlettAttila FrigyYury GrinshteinSholpan ZhangelovaOleg ShtegmanEndre ZimaElena KosmachevaCaroline DalySofian JoharRuxandra ChristodorescuKuan Leong YewNathan DwyerSergey YakushinCatalin Adrian BuzeaMartin CowieDulce BritoAlbert GalyavichGulnara JunusbekovaSergei ShalaevInna ViktorovaAlexandru NechitaLuigi TavazziWanwarang WongcharoenAdisai BuakhamsriJoanna PlonkaSvetlana BolduevaPiotr PonikowskiRuslan NajafovAlexander KastanayanNiall MahonDmitry ZateyshchikovYury VasyukGeorge GiannakoulasEwa Lewickasubject
Malemedicine.medical_specialtyDoseMedication Therapy ManagementHeart failureOutcomes030204 cardiovascular system & hematologyGuidelinesMedication03 medical and health sciences0302 clinical medicineDosageInternal medicineMedication therapy managementOutcome Assessment Health CareOutpatientsmedicineHumansRegistriesPractice Patterns Physicians'Heart FailureEjection fractionGuideline adherencebusiness.industryCardiovascular AgentsStroke VolumeStroke volumeMiddle Agedmedicine.diseaseQuality ImprovementConfidence intervalClinical trialHospitalizationAdherenceHeart failureCardiovascular agentAmbulatoryPractice Guidelines as TopicObservational studyFemaleGuideline AdherenceCardiology and Cardiovascular MedicinebusinessFollow-Up Studiesdescription
Background Physicians’ adherence to guideline-recommended therapy is associated with short-term clinical outcomes in heart failure (HF) with reduced ejection fraction (HFrEF). However, its impact on longer-term outcomes is poorly documented. In this analysis we assessed the longer-term association of physicians’ adherence with clinical outcomes, including mortality and unplanned hospitalisations, at 18-month follow-up of the QUALIFY registry (Clinical trial registration ISRCTN87465420) Method and results Data at 18 months were available for 6118 ambulatory HFrEF patients from this international prospective observational survey. Adherence was measured as a continuous variable, ranging from 0 to 1, and was assessed with regard to five classes of recommended HF medications and dosages. Most deaths were cardiovascular (CV) (228/394) and HF-related (191/394) and the same was true for unplanned hospitalisations (1175 CV and 861 HF-related hospitalisations, out of a total of 1541). According to univariable analysis, CV and HF deaths were significantly associated with physician adherence to guidelines. In multivariable analysis, HF death was associated with adherence level [subdistribution hazard ratio (SHR) 0.93, 95% confidence interval (CI) 0.87–0.99 per 0.1 unit adherence level increase; P = 0.034] as was composite of HF hospitalisation or CV death (SHR 0.97, 95% CI 0.94–0.99 per 0.1 unit adherence level increase; P = 0.043), whereas unplanned all-cause, CV or HF hospitalisations were not (all-cause: SHR 0.99, 95% CI 0.9–1.02; CV: SHR 0.98, 95% CI 0.96–1.01; and HF: SHR 0.99, 95% CI 0.96–1.02 per 0.1 unit change in adherence score; P = 0.52, P = 0.2, and P = 0.4, respectively). Conclusion These results suggest that physicians’ adherence to guideline-recommended HF therapies is associated with improved outcomes in HFrEF. Practical strategies should be established to improve physicians’ adherence to guidelines.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2019-01-01 | European journal of heart failure |