Dose matters! Optimisation of guideline adherence is associated with lower mortality in stable patients with chronic heart failure

Poelzl, Gerhard; Altenberger, Johann; Pacher, Richard; Ebner, Christian; Wieser, Manfred; Winter, Angela; Fruhwald, Friedrich; Dornaus, C.; U, Ehmsen; Reiter, Susanne; Steinacher, Richard; Huelsmann, M; Eder, V.; Boehmer, Armin; Pilgersdorfer, L; Ablasser, Klemens; Keroe, D; H, Groebner; Auer, Johann; Jakl, G; Hallas, Andreas; Ess, Michael; Ulmer, Hanno

doi:10.1016/j.ijcard.2014.04.255

Cited by 60 publications

(100 citation statements)

References 20 publications

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“…14 Similarly, in the Austrian Heart Failure Registry, improved guideline adherence related to dose escalation towards optimal levels was associated with reduced long-term mortality in ambulatory HFrEF patients surviving 1 year after registration. 15 …”

Section: Clinical Practicementioning

confidence: 99%

Quality of Physician Adherence to Guideline Recommendations for Life-saving Treatment in Heart Failure: an International Survey

Cowie¹,

Komajda²

2017

Cardiac Failure Review

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Access at: www.CFRjournal.com Advances in diagnosis and treatment have improved the outlook for the estimated 26 million patients with heart failure (HF) worldwide, 1 but there remains a continuing need for further reduction in mortality and hospitalisation and the associated social and financial consequences of the disease. In a European study of outcomes after HF hospitalisation, 17 % of patients died within 12 months and 44 % were rehospitalised, 2 and the most recent data from the British National Heart Failure Audit showed in-hospital mortality of 8.9 % and mortality at 1 year of 26.7 % in those surviving to leave hospital. 3 Patients are at greatest risk in the first 30 days after hospitalisation, 4 though there is some evidence that good adherence to HF treatment guidelines may improve clinical outcomes. 5 The latest HF guidelines from the European Society of Cardiology (ESC) recommend key pharmacological therapies for patients with HF with reduced ejection fraction (HFrEF) in order to reduce mortality and hospitalisation. 6 These include angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs) if ACEIs are not tolerated, beta blockers (BBs), mineralocorticoid receptor antagonists (MRAs), ivabradine for patients in sinus rhythm with a heart rate ≥70 bpm, and sacubitril/valsartan as a replacement for ACEIs in ambulatory patients with HFrEF who remain symptomatic despite optimal ACEI, BB and MRA treatment (Figure 1). 6 Yet, even when prescription levels of guidelines-based HF treatment are high, patients may fail to reach target doses of potentially lifesaving medicines, 7 and there is some evidence that suboptimal dosing may adversely influence outcomes. 8,9 QUALIFY (QUality of Adherence to guideline recommendations for LIFe-saving treatment in heart failure surveY) was initiated to improve understanding of the impact of physicians' adherence to guideline Physicians' adherence scores and follow-up data have been reported for 6,669 patients with chronic heart failure and left ventricular ejection fraction ≤40 % who had been hospitalised for worsening HF in the previous 1-15 months. 12 Patients were treated at 547 centres in 36 countries in Africa, Asia, Australia, Europe, the Middle East and North, Central and South America (Figure 2). 10,12 Measuring Physicians' AdherenceThe focus of QUALIFY was on physicians' adherence to HF guidelines and did not include patient adherence to prescribed treatment. The adherence score used in QUALIFY was the ratio of the treatment actually prescribed to the treatment that should theoretically have been prescribed. The latter took account of eligibility criteria, guidelines-based contraindications to drugs or treatments and use in ≥50 % of recommended dosages. Target doses were defined by ESC guidelines when available 11 and, in the case of ivabradine, according Abstract QUALIFY (QUality of Adherence to guideline recommendations for LIFe-saving treatment in heart failure surveY) showed that good physician adherence to guideline recommendations ...

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Section: Clinical Practicementioning

confidence: 99%

Quality of Physician Adherence to Guideline Recommendations for Life-saving Treatment in Heart Failure: an International Survey

Cowie¹,

Komajda²

2017

Cardiac Failure Review

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“…There are subgroup analyses supporting that mortality benefit is observed even 6.25 mg daily dose of carvedilol and 1.25-3.75 mg daily dose of bisoprolol. After initiating ACEI/ARB therapy, adding BB therapy before achieving the target dose is important in terms of mortality and morbidity (27). In a clinical trial conducted in Austria, it was demonstrated that adjusting treatment in accordance with the guidelines reduced all-cause mortality in patients with HF-REF (27).…”

Section: 8mentioning

confidence: 99%

“…After initiating ACEI/ARB therapy, adding BB therapy before achieving the target dose is important in terms of mortality and morbidity (27). In a clinical trial conducted in Austria, it was demonstrated that adjusting treatment in accordance with the guidelines reduced all-cause mortality in patients with HF-REF (27). When the study group is examined, the percentage of patients who received ACEI/ARB, BB and MRA therapies were 90.5%, 87.8% and 42.7%, respectively and the percentage of patients receiving drugs in target doses was less than 50%.…”

Section: 8mentioning

confidence: 99%

Practical approaches for the treatment of chronic heart failure: Frequently asked questions, overlooked points and controversial issues in current clinical practice

Çavuşoğlu

Altay²,

Ekmekçi³

et al. 2015

Anatol J Cardiol

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Practical approaches for the treatment of chronic heart failure:Frequently asked questions, overlooked points and controversial issues in current clinical practiceHeart failure (HF) is a progressive disorder associated with impaired quality of life, high morbidity, mortality and frequent hospitalization and affects millions of people from all around the world. Despite further improvements in HF therapy, mortality and morbidity remains to be very high. The life-long treatment, frequent hospitalization, and sophisticated and very expensive device therapies for HF also leads a substantial economic burden on the health care system. Therefore, implementation of evidence-based guideline-recommended therapy is very important to overcome its worse clinical outcomes. However, HF therapy is a long process that has many drawbacks and sometimes HF guidelines cannot answers to every question which rises in everyday clinical practice. In this paper, commonly encountered questions, overlooked points, controversial issues, management strategies in grey zone and problems arising during follow up of a HF patient in real life clinical practice have been addressed in the form of expert opinions based on the available data in the literature. (Anatol J Cardiol 2015: 15 Suppl 2; 1-60)

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“…Since by design only the patients who were tolerant to ACE-I were recruited to the Val-HeFT study, during the course of the study even this 7% intolerance should be disturbing. In current regitries looking for the rates of ACE-I and ARB use in HF in real life, it can be seen that ARBs are used at a rate of 20%-35% (26)(27)(28). In an evaluation made in the Cochrane database, it was detected that the rate of patients quitting the treatment because of undesired effects was 37% lower in the ARB group [RR 0.63 (95% CI 0.52, 0.76)] than in the ACE-I group (29).…”

Section: Angiotensin Receptor Blockers In Hf Treatmentmentioning

confidence: 99%

Renin-angiotensin system blockade in the treatment of heart failure and the role of valsartan in this treatment

Avcı¹,

İkitimur²,

Karadağ³

et al. 2015

Anadolu Kardiyol Derg

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Heart failure which occurs due to various causes including primarily coronary artery diseases and hypertension is a syndrome with complex physiopathology and clinic that can impair patients' quality of life or lead to death. However, it is well known that the activation of renin-angiotensin system (RAS) has an important role in the physiopathology of heart failure with reduced ejection fraction. Therefore, suppression of this system for achieving a gain in the treatment of the disease has been among prominent concerns. In this review, the place of RAS suppressive drugs and valsartan, which is an angiotensin receptor blocker, in heart failure will be examined. (Anadolu Kardiyol Derg 2014; 14(Suppl 2): S1-S8)

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Dose matters! Optimisation of guideline adherence is associated with lower mortality in stable patients with chronic heart failure

Cited by 60 publications

References 20 publications

Quality of Physician Adherence to Guideline Recommendations for Life-saving Treatment in Heart Failure: an International Survey

Quality of Physician Adherence to Guideline Recommendations for Life-saving Treatment in Heart Failure: an International Survey

Practical approaches for the treatment of chronic heart failure: Frequently asked questions, overlooked points and controversial issues in current clinical practice

Renin-angiotensin system blockade in the treatment of heart failure and the role of valsartan in this treatment

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