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Eur J Heart Fail. 2019 Apr 1. doi: 10.1002/ejhf.1459. [Epub ahead of print]

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

Collaborators (644)

Aleksanyan A, Atayan L, Avetisyan A, Davtyan N, Drambyan M, Gevorgyan K, Grigoryan M, Hakobyan Z, Hayrapetyan H, Kocharyan L, Kramarevskaya T, Melqonyan A, Muradyan F, Nanyan R, Ordyan A, Ordyan M, Piruzyan A, Podosyan G, Safaryan K, Sargsyan T, Sarkisyan A, Sisakyan H, Ter-Grigoryan V, Ustyan T, Alexopoulos C, Amerena J, Arstall M, Ayres B, Barron G, Beltrame J, Bou-Samra J, Brown M, Cross D, Dwyer N, Eccleston N, Hare D, Ho B, Hopper I, Jackson B, Korczyk D, Lattimore JD, Levendel A, Macfadyen R, Pandeli V, Playford D, Richardson M, Senior JA, Shah A, Shetty P, Soward A, Srivastava P, Swale M, Vogl E, Wai B, William M, Worthington A, Wright S, Brunner B, Fuhrmann W, Horer L, Maca T, Nahler A, Ortner H, Racz G, Scheibner P, Sebald C, Abdullayev A, Abdullayev R, Ahmadov A, Alakbarov E, Aliyev F, Aliyev F, Bakhshaliyev A, Bakhshiyev M, Dadashova G, Dashdamirov R, Faradjova N, Guliyev A, Guliyev F, Guliyeva S, Hajiyev G, Ibrahimov F, Imanov G, Isayeva A, Isayeva M, Jabrailova U, Jafarov R, Jahangirov T, Khalilov A, Khalilov S, Mehdiyev S, Najafov R, Samedova H, Shahhuseynov S, Yusifly R, Yusifov T, Zahidova K, Zeynalov A, Abdullatif A, Al-Banna R, Haiky W, Husain A, Jamsheer A, Barbuk O, Belskaya M, Borodko V, Kurlianskaya A, Mackevich S, Mankevich N, Moroz-Vodolazhskaya N, Ravtovich O, Saevich A, Troyanova T, Chughtai A, Johar S, Luqman N, Nair TC, Deyoung P, Ezekowitz J, Frenette M, Howlett J, Huynh T, Nguyen V, Toma M, Orenstein T, Rinne MRC, Virani S, Zieroth S, Ailiman M, Cong H, Ding W, Dong W, Dong Y, Gao C, Li L, Li Z, Liang Y, Liu X, Liu S, Luo S, Shi H, Tian Q, Wang D, Wang J, Wei M, Wu C, Xu D, Yang X, Yang Z, Zhang C, Zhang Q, Zhang Y, Zhang R, Zheng Y, Zhao L, Zhou J, Buch P, Davidsen F, Eiskjaer H, Bruun NE, Kragh-Thomsen NE, Franow H, Køber L, Korup E, Madsen BK, Mikkelsen K, Nielsen KA, Nørgaard A, Refsgaard J, Rickers H, Kaiser P, Sykulski R, Zeuthen EL, El Fottoh AA, El Badry M, El Hady YA, El Kady E, El Khatib H, Fawzy M, Hegazy H, Salama MK, Mortada A, Mostafa T, Mwafy A, Ossama M, Samir S, Seleem M, Sobhy B, Bregadze G, Chelidze K, Chumburidze V, Jalabadze K, Khabeishvili G, Kiphiani Z, Klimiashvili Z, Kvitsiani A, Mamatsashvili M, Melia IMA, Oragvelidze T, Orjonikidze S, Paposhvili K, Petriashvili S, Phaghava Z, Shushania M, Tsetskhladze E, Tsinamdzgvishvili B, Abdel-Qader M, Al-Zoebi A, Böhm G, Bosch R, Brune S, Bunge K, Dominick K, Duda S, Erdogan AE, Faber G, Fach C, Fechtrup C, Frickel S, Giokoglu K, Haas J, Hagenow A, Haj-Yehia A, Hansen C, Hartung WM, Hauser ER, Hofmeister A, Hohensee H, Hüttemann M, Keim M, Krämer A, Langwasser K, Lodde BP, Lorch G, Lüer C, Müller K, Placke J, Plesch B, Potolidis L, Richter F, Rieker WA, Schlichting J, Stenzel G, Theuer JD, Marcin A, Warkentin R, Wegner M, Wilke A, Agrafiotis I, Aleksandridis I, Farmakis D, Giannakoulas G, Karavidas A, Lamprou A, Ninios V, Panagiotopoulos K, Papadopoulos K, Siachos S, Dékány M, Borbéy A, Borsányi T, Forster T, Gavallér H, Gyuricza I, Heltai K, Herczeg B, HŐgye M, Losonczi I, Merkely B, Metz E, Muk B, Nagy K, Ökrös M, Piry K, Poós G, Sárszegi Z, Somogyi T, Sziliczei-Németh E, Tátrai T, Zima E, Zsigmond A, Daly C, Mahon N, Meany B, Abbdi I, Awaysheh R, Azouka M, Hamoudeh S, Nammas A, Okkeh O, Aimakova G, Ismagulova Z, Issabekova A, Junusbekova GA, Koshumbayeva K, Madaliyev K, Mekebekova D, Mukatova A, Ospanova G, Sadvakassova G, Sunkarbekova Z, Yegorova Y, Zhangelova S, Kim KH, Al-Mutairi M, Gaber Y, Ghali I, Ghanem A, Hafez H, Haiba M, Koushy T, Mahmoud A, Raafat G, Sallam M, Senousi O, Soliman M, Massih TA, Ali SA, Jaoude SA, Azzi N, Badaoui G, Bayeh H, Beydoun A, Chammas E, Dib H, Gebran M, Ghanem G, Haidar H, Hamadeh M, Hamoui O, Hobeika R, Jazra C, Kabbani S, Kadri Z, Karanaminassian R, Kassab R, Kleit M, Mansour H, Mousallem N, Semaan C, Simonian A, Sarkis A, Succar S, Zalloum R, Zind R, Anusauskiene J, Grigaliuniene A, Karaliute R, Kavoliuniene A, Kozlovaite V, Miliuniene D, Rinkuniene D, Rudys A, Stasaityte D, Aziz FAA, Rahim AAA, Ahmad R, Ahmadsah SHKA, Ang CC, Ang SH, Cham YL, Chee KH, Chooi KC, Chu CM, Fam TL, Fong A, Ismail O, Ismail JR, Kamarulzaman MH, Kasim SS, Khiew NZ, Krishnan C, Krishinan S, Lau G, Lee LY, Liew HB, Lim CW, Mahendran K, Dass RDM, Mohamad R, Arshad MKM, Unit HM, Mustapha Z, Ng WK, Ong TK, Oon YY, Ramli AW, Ramanathan GRL, Ross NT, Said A, Sarwar M, Tan E, Tan SK, Voon CY, Yusoff MR, Abidin HAZ, Chua SK, Yew KL, Amin NHM, Kandiah K, Chong LA, Mohamed MS, Lim BK, Koh KT, Low DW, Abdelkhirane C, Allali Y, Askour M, Balafrej K, Bendagha N, Bendriss L, Benjelloun H, Chaib A, Cherradi G, Cherti M, Chtioui M, El Belghiti AR, Fihri OF, Habbal R, El Hattaoui M, Khatouri A, Kheyi J, Kriem J, Soufiane N, Soufiani A, Zaimi S, Adamczyk-Kot D, Barg Z, Bartkowiak R, Braciszewicz W, Czajkowska E, Dudek-Niechciał M, Grzelakowski P, Jarosik Z, Jerzykowska O, Koprowski P, Krysiak W, Łajkowski Z, Ziemlewska-Krawczyk E, Lelonek M, Lewicka E, Płonka J, Sadowski J, StĘpieŃ-Adamczewska V, Szponar J, WrzesiŃski K, Brito DA, Araújo I, Figueiredo JPA, Campelo MB, Sardinha PMB, Fernando P, de Brito Domingues Sanches Peres de Noronha MA, Baptista SBC, Cardoso Pinto JP, Piçarra BMC, Farto E Abreu P, da Fonseca MCFG, Soares AICGO, Resende JDA, Durão DL, Nascimento AIFV, Bernardes ELMO, Marques F, Ramos MAN, Sargento LJM, Dos Santos JPF, Raimundo A, da Luz Ventosa AMS, Sarmento P, Aguiar CMT, Ahmed E, Al-Suwaidi J, Al Dabdoob W, Badr A, Gomaa M, Albu M, Antohi I, Apavaloaei C, Ardelean A, Badea G, Bicescu G, Blaj C, Bogdan L, Bucatanschi M, Buzea A, Calarasu V, Catinean S, Christodorescu R, Cocoi D, Costache L, Cretu D, Crisu D, Dima-Cozma C, Dumitrescu S, Enache V, Firastrau V, Frigy A, Gherghina A, Girbea S, Gutu A, Horovitz M, Hortopan G, Istratoaie O, Jianu C, Jinga L, Lighezan D, Luka A, Magheru S, Mercea D, Miklos K, Moga R, Oprea N, Paraschiv DM, Pop D, Rusu R, Sirbu I, Socoteanu E, Stanciulescu G, Suteu A, Tetiu O, Traistaru A, Tudoran M, Turiceanu MC, Viinkler L, Adonina E, Akinina S, Alferov P, Arkhipov M, Aroutunov G, Babkin A, Barbashina T, Bochkareva J, Boldueva S, Bukhonkina J, Chumakova SG, Fayans I, Furmenko G, Galyavich A, Grinstein Y, Klein G, Kastanayan A, Kazachkova T, Korolev S, Koshelskaya O, Kosmacheva E, Koziolova N, Kuimov A, Kushnarenko N, Lebedev P, Matushin G, Mineeva E, Motylev I, Nedbaykin A, Nevzorova V, Rachkova S, Rebrov A, Reznik I, Saiganov S, Sayfutdinov R, Schekotov V, Serdechnaya E, Shalaev S, Shtegman O, Sitnikova M, Smolenskaya O, Sulimov V, Tarlovskaya E, Temnikova E, Timonin D, Tolstov S, Uskatch T, Ustyuzhanin V, Valeeva R, Vasyuk Y, Viktorova I, Yakushin S, Zadionchenko V, Zateischikov D, Zhirov I, Bollová D, Dulková K, Fazekaš F, Hermel I, KŇazeje M, NedĚĽová I, Nociar J, Procházka L, Pundová L, Slanina M, Varga I, Almenar L, Beltrán P, Cobo M, Delgado J, Enjuanes C, Garrido I, Gómez MA, Manito N, Marzal D, Murga N, Ocampo M, Pérez J, Sánchez I, Buakhamsri A, Leemasawat K, Kanoksilp A, Kiatchoosakun S, Phrommintikul A, Porapakkham P, Rodprasert S, Senthong V, Wongcharoen W, Wongwantanee S, Bahadir H, Emül A, Gokce M, Gurcagan A, Kaya OK, Keser A, Pinar P, Taș MH, Tosun HB, Yazlar AS, Yilmaz S, Yuksel Y, Bagriy A, Ivchyna N, Lyashenko A, Matviychuk N, Shchukina O, Tkach N, Tseluyko V, Vasylieva L, Abdallah A, Agrawal A, Basleeb F, Bazargani N, Hatou E, Al Kaddour AR, Al Kasser M, Al Mulla A, Radaideh G, Salustri A.

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.

KEYWORDS:

Adherence; Dosage; Guidelines; Heart failure; Medication; Outcomes

PMID:
30933403
DOI:
10.1002/ejhf.1459

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