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

Abstract

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 ...

Avaliação do uso de soros antivenenos na emergência de um hospital público regional de Vitória da Conquista (BA), Brasil

“…Despite the wide dissemination of clinical guidelines, some studies point to problems with little or no adherence to treatment protocols in the most diverse areas 29,30 . Other studies show that it is necessary to know the factors underlying the decision-making of these professionals [32][33][34] to understand the varying prescriptions among prescribers.…”

“…In 2016, the Brazilian Ministry of Health issued a note with guidelines on the need to adjust antivenom doses indicated for treatment due to jararacas and scorpion bites in an attempt to reduce waste, without prejudice to envenomation victims 28 . However, several studies have shown low adherence of health professionals to the recommendations of clinical guidelines in several areas 29,30 . This study aims to characterize the epidemiological profile of users who are victims of scorpion and snakebite accidents and to evaluate the suitability of antivenom sera prescriptions in the emergency service of a regional hospital.…”

Treatment optimization of beta-blockers in chronic heart failure therapy

“…In the majority of patients with chronic HF, target doses of beta-blockers are achievable and tolerable 21 , 25 , 26 . Hence, beta–blockers should be titrated to attain a target dose or a maximum tolerable dose to get a maximum clinical benefit 11 , 12 , 27 .…”

Utilization and Dose Optimization of Angiotensin-Converting Enzyme Inhibitors among Heart Failure Patients in Southwest Ethiopia

“…ACEIs have been proved to have mortality and morbidity benefits in patients with systolic HF in several clinical trials [10–13]. In HF patients with reduced ejection fraction, ACEIs therapy leads to symptomatic improvement, reduced hospitalization, and enhanced survival [10, 14].…”

“…ACEI uptitration to a maximum tolerable dose is important in chronic HF patients to reduce the incidence of hospitalization, morbidity, and mortality as well as improve the quality of life of the patients [17–19]. Several studies indicated that a target dose of ACEI is achievable in the majority of chronic HF patients and the achieved optimal dose was associated with better treatment outcomes [4, 14, 17, 18]. Therefore, every effort should be made to achieve the target dose or maximum tolerable dose to get the maximum clinical benefit [6, 7].…”