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

Eur J Heart Fail. 2019 Jul;21(7):921-929. doi: 10.1002/ejhf.1459. Epub 2019 Apr 1.

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiovascular Agents* / classification
  • Cardiovascular Agents* / therapeutic use
  • Female
  • Follow-Up Studies
  • Guideline Adherence / statistics & numerical data*
  • Heart Failure* / drug therapy
  • Heart Failure* / mortality
  • Heart Failure* / physiopathology
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Medication Therapy Management* / standards
  • Medication Therapy Management* / statistics & numerical data
  • Middle Aged
  • Outcome Assessment, Health Care
  • Outpatients / statistics & numerical data
  • Practice Guidelines as Topic*
  • Practice Patterns, Physicians'* / standards
  • Practice Patterns, Physicians'* / statistics & numerical data
  • Quality Improvement
  • Registries / statistics & numerical data
  • Stroke Volume

Substances

  • Cardiovascular Agents

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