General practitioners' adherence to chronic heart failure guidelines regarding medication: the GP-HF study

Abstract

Guideline adherence of GPs was higher than expected from literature and might be further improved by highlighting MRAs as the third prognostically relevant drug class beside ACEIs/ARBs and BBs and stronger emphasis on target doses.

A tool for assessment of heart failure prescribing quality: A systematic review and meta‐analysis

“…Most recently, Hirt et al and Oertle et al included a qualitative aspect in their GAI studies and showed that GAI is significantly higher when quantitative as well as qualitative patient data are considered. This supports previous data showing that patient and prescriber factors may be important barriers to guideline adherence .…”

“…The characteristics of each included study are shown in Table 1 The studies reported the use of guideline adherence assessment tools in several different health care settings including 8 studies performed in ambulatory care, 18,21,25,27,[30][31][32][33] 6 studies in primary care, 22,24,26,28,32,34 and 7 studies in hospital inpatient settings. 21,23,26,27,29,31,35 Seven studies 18,25,27,[30][31][32]35 included a followup period of 6 to 12 months while two studies 21,23 reported a follow-up period of almost 2 years.…”

BETAWIN-AHF study: effect of beta-blocker withdrawal during acute decompensation in patients with chronic heart failure

“…Advanced age of AHF patients in the real world is a fact (not always properly recorded in clinical trials [24]) that Finally, it is imaginable that emergency physicians trust that BB will be reintroduced during patient's hospitalization or once patient is discharged, or once the clinical patient condition improves. The adherence to guidelines, in such scenarios where patient has been stabilized, is higher than in the EDs [29]. However, this latter aspect was not ascertained in our study, because we only recorded BBW, but not BB reintroduction.…”

Heart failure in patients with coronary heart disease: Prevalence, characteristics and guideline implementation – Results from the German EuroAspire IV cohort

“…Recent data from 15 randomly chosen general practitioners in the metropolitan region of Hamburg, Germany, showed high prescription rate of ACEi/ARB (76%), beta-blockers (73%), and MRA (18%) in outpatients with chronic HF [43]. However, after collective review of patient records and subsequent counselling, prescription rates could further be improved (ACEi/ARB: 87%, beta-blocker: 84%), and GAI-3 increased from 22% to 56% [43]. …”

“…Since this observation is based on small numbers, it awaits corroboration in larger samples. The hesitation to prescribe MRA might be due to the higher likelihood of potential adverse events requiring a closer patient monitoring, but also because the importance of MRA regarding favourable prognosis may have not yet sufficiently transferred to the outpatient setting [43]. …”