Physicians' adherence to guideline‐recommended medications in heart failure with reduced ejection fraction: data from the QUALIFY global survey

Abstract

Aims To assess physicians' adherence to guideline‐recommended medications for the treatment of chronic heart failure (CHF) with reduced ejection fraction. Methods and results QUALIFY is an international prospective observational longitudinal survey of 7092 CHF outpatients recruited 1–15 months after hospitalization for heart failure from September 2013 to December 2014 in 547 centres in 36 countries. We constructed a five‐class guideline adherence score for angiotensin converting enzyme inhibitors (ACEIs), beta‐blockers, angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists, and ivabradine. The adherence score was good in 67%, moderate in 25%, and poor in 8% of patients. Adherence was lower in women than men but there were differences in age (65.7 ± 12.5 years women vs. 62.2 ± 12.4 years men, P < 0.001) and the proportion of women at ≥50% target dose of beta‐blockers was lower in those >67 years (median) (11% vs. 16.2%, P = 0.005). Geographic variations were observed with lower adherence scores in Central/Eastern European countries. The proportion of patients at target dose and ≥50% of target dose was low (27.9% and 63.3% for ACEIs, 14.8% and 51.8% for beta‐blockers, 6.9% and 39.5% for ARBs, and 6.9% and 39.5% for ivabradine, respectively). It was also lower in patients most recently hospitalized (<6 vs. ≥6 months) except for beta‐blockers. Conclusion This international survey shows that adherence to guideline‐recommended medications is relatively satisfactory but the dosage of recommended CHF medications is usually suboptimal. Action plans aimed at improving adherence to guidelines are required.

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

“…In an earlier QUALIFY paper, we reported good overall adherence to ACEI/ARB, BB, MRA and ivabradine treatment of 67 %, 10 and this was in line with data from the British National Heart Failure Audit. 3 However, as shown in the current analysis, good adherence was achieved in fewer than one-quarter of patients when drug dosages were taken into account.…”

“…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.…”

“…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' Adherence…”

Heart failure in elderly patients: differences in clinical characteristics and predictors of 1-year outcome in the Polish ESC-HF Long-Term Registry

“…Surprisingly, the use of β-blockers was beneficial in patients aged 65 years or older, but not in the subgroups of elderly patients (there was a trend in patients aged 75 years or older; P = 0.06). This might be due to a decreasing use of appropriate doses of β-blockers in elderly patients, 34 and a worse response to β-adrenergic blockade in elderly patients with reduced LVEF.…”

Medical Inertia in the Optimization of Heart Failure Treatment after Discharge and its Relationship to Outcome

“…Medical ineatia have a potential impaction on outcomein heart failure. are numerous, including the patient's condition (age, comorbidities, adherence) as well as the physician's choices (ignorance of the guidelines, misgivings about new treatment, focus on patient symptoms rather than reduction of mortality), and access to health care [9][10][11][12][13][14]. However, data on changes in treatment over follow-up are scarce, particularly during the early follow-up of patients after an acute HF event.…”