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Isr Med Assoc J. 2009 Jun;11(6):348-53.

Adherence to guidelines improves the clinical outcome of patients with acutely decompensated heart failure.

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Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel.



Acutely decompensated heart failure/pulmonary edema is one of the most common medical problems in clinical practice. Approximately 500 patients are admitted to Rambam Health Care Campus yearly with the diagnosis of ADHF/PE. As a result, Rambam established local instructions and guidelines for the treatment of ADHF/PE based on the guidelines published by the American Heart Association, American College of Cardiology and The European Society of Cardiology.


To examine whether adherence to guidelines improves the outcome of patients with ADHF/PE in internal medicine wards.


Data were collected from the charts of 78 patients admitted to Rambam with ADHF/PE and were compared to a matched historic cohort.


Echocardiography was performed more commonly in the study group patients as compared to the control group, 85% vs. 37.7% respectively (P = 0.0001). In patients who were treated according to the guidelines, angiotensin-converting enzyme inhibitors and beta-blockers were prescribed more commonly as compared to the control group. The 3 month mortality rate was significantly lower in the study group (P = 0.021).


Adherence to guidelines for treatment of ADHF/PE decreased the short-term mortality and increased the use of medications known to reduce mortality and morbidity in patients with systolic heart failure. Echocardiography is an important tool to guide treatment of ADHF/PE.

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