Physicians' guideline adherence is associated with long‐term heart failure mortality in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry. (1st April 2019)

• Record Type: Journal Article
• Authors: Komajda, Michel; Schöpe, Jakob; Wagenpfeil, Stefan; Tavazzi, Luigi; Böhm, Michael; Ponikowski, Piotr; Anker, Stefan D.; Filippatos, Gerasimos S.; Cowie, Martin R.
• Other Names: Aleksanyan A. investigator.; Atayan L. investigator.; Avetisyan A. investigator.; Davtyan N. investigator.; Drambyan M. investigator.; Gevorgyan K. investigator.; Grigoryan M. investigator.; Hakobyan Z. investigator.; Hayrapetyan H. investigator.; Kocharyan L. investigator.; Kramarevskaya T. investigator.; Melqonyan A. investigator.; Muradyan F. investigator.; Nanyan R. investigator.; Ordyan A. investigator.; Ordyan M. investigator.; Piruzyan A. investigator.; Podosyan G. investigator.; Safaryan K. investigator.; Sargsyan T. investigator.; Sarkisyan A. investigator.; Sisakyan H. investigator.; Ter‐Grigoryan V. investigator.; Ustyan T. investigator.; Alexopoulos C. investigator.; Amerena J. investigator.; Arstall M. investigator.; Ayres B. investigator.; Barron G. investigator.; Beltrame J. investigator.; Bou‐Samra J. investigator.; Brown M. investigator.; Cross D. investigator.; Dwyer N. investigator.; Eccleston N. investigator.; Hare D. investigator.; Ho B. investigator.; Hopper I. investigator.; Jackson B. investigator.; Korczyk D. investigator.; Lattimore J.D. investigator.; Levendel A. investigator.; Macfadyen R. investigator.; Pandeli V. investigator.; Playford D. investigator.; Richardson M. investigator.; Senior J. 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• Is Part Of: European journal of heart failure. Volume 21:Number 7(2019)
• Page Start: 921
• Page End: 929
• Publication Date: 2019-04-01
• Subjects: Heart failure -- Guidelines -- Adherence -- Medication -- Dosage -- Outcomes; Heart failure -- Periodicals; Heart Failure -- Periodicals; Insuffisance cardiaque -- Périodiques; Heart failure; Periodicals; 616.129005
• DOI: 10.1002/ejhf.1459
• Languages: English
• ISSNs: 1388-9842

Abstract

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.