Physicians' guideline adherence is associated with long‐term heart failure mortality in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry

Abstract

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. Here, we present results from the 18‐month follow‐up of the QUALIFY registry. Methods 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 for 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 hospitalizations (1175 CV and 861 HF‐related hospitalizations, 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 hospitalization 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 hospitalizations 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.

Sex‐ and age‐related differences in the management and outcomes of chronic heart failure: an analysis of patients from the ESC HFA EORP Heart Failure Long‐Term Registry

“…However, older age (>75 years) independently predicted a lower use of GDMT and a higher rate of all‐cause mortality. Although the reasons behind the disparities observed may be complex, it is important to raise awareness among physicians of the fact that persistence in obtaining the optimal management of patients with HF is of crucial importance in improving outcomes . Further research into the causes of undertreatment of HF in elderly patients may provide important insights that will facilitate the improvement of treatment options.…”

Estimating lifetime benefits of comprehensive disease-modifying pharmacological therapies in patients with heart failure with reduced ejection fraction: a comparative analysis of three randomised controlled trials

“…While most patients are currently treated with renin-angiotensin-system inhibitors (RASi) and βblockers, [3][4][5] three drug classes have additionally been shown to reduce mortality in HFrEF beyond these previously established core elements. Trials have demonstrated clinical superiority of mineralocorticoid receptor antagonists (MRA) 6,7 and sodium-glucose cotransporter-2 inhibitors (SGLT2i) 8 when each was tested against a placebo control in addition to standard care inclusive of RASi and β-blockers (as tolerated).…”

January 2020 at a glance: translational medicine, predictors of outcome and treatments

“…Ageing is an established major determinant of adequacy and adherence to treatment and of survival in patients with HF . Lainščak et al .…”