Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC Heart Failure Long‐Term Registry

European Journal of Heart Failure - Tập 15 Số 10 - Trang 1173-1184 - 2013
Aldo P. Maggioni1, Stefan D. Anker2, Ulf Dahlström3, Gerasimos Filippatos4, Piotr Ponikowski5, Faı̈ez Zannad6, Offer Amir7, Ovidiu Chioncel8, María G. Crespo‐Leiro9, Jarosław Dróżdż10, Andrejs Ērglis11, Emir Fazlibegović12, Cândida Fonseca13, Friedrich Fruhwald14, Plamen Gatzov15, Eva Gonçalvesová16, Mahmoud Hassanein17, J Hradec18, Aušra Kavoliūnienė19, Mitja Lainščak20, Damien Logeart21, Béla Merkely22, Marco Metra23, Hans Persson24, Petar Seferović25, Ahmet Temizhan26, Dimitris Tousoulis27, Luigi Tavazzi28
1ANMCO Research Center, Florence, Italy
2Applied Cachexia Research, Department of Cardiology, Charité Medical School, Campus Virchow–Klinikum, Berlin, Germany
3Department of Cardiology, Linkoping University Hospital, Linkoping, Sweden
4Athens University Hospital “Attikon”, Athens, Greece
5Department of Cardiology, Military Hospital, Wroclaw, Poland
6Inserm, Centre d'Investigation Cliniques CIC 9501 and U961, CHU and Department of Cardiology Nancy University Nancy France
7Lady Davis Carmel Medical Centre Israel
8Cardiology 1, Institut de Boli Cardiovasculare C.C.Iliescu, Bucuresti, Romania
9Unidad de Insuficiencia Cardiaca Avanzada y Trasplante Cardiaco, Hospital Universitario A Coruña, La Coruña, Spain
10Department of Cardiology, Medical University of Lodz, Lodz, Poland
11Pauls Stradins Clinical University Hospital, Riga, Latvia
12Clinical Hospital Mostar Mostar Bosnia Herzegovina
13S. Francisco Xavier Hospital, New University of Lisbon Lisbon Portugal
14Department of Cardiology, Medical University Graz, Austria
15University Hospital Lozenets Sofia Bulgaria
16National Institute of Cardiovasc Diseases–NUSCH, Bratislava Slovak Republic
17Alexandria University, Alexandria, Egypt
183rd Dept of Medicine, Faculty General Hospital Charles University Prague Czech Republic
19Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
20Division of Cardiology, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
21Department of Cardiology, INSERM UMR 942 Lariboisière Hospital Paris France
22Semmelweis University, Heart Center, Budapest, Hungary
23Cattedra di Cardiologia, Dipartimento di medicina sperimentale ed applicata, Spedali Civili Università di Brescia Brescia Italy
24Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
25Department of Cardiology, Clinical Centre of Serbia, Belgrade, Serbia
26Turkey Yüksek Ihtisas Hospital, Cardiology Clinic Ankara Turkey
271st Cardiology Department, Athens University Medical School, Athens, Greece
28Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy

Tóm tắt

AimsTo evaluate how recommendations of European guidelines regarding pharmacological and non‐pharmacological treatments for heart failure (HF) are adopted in clinical practice.Methods and resultsThe ESC‐HF Long‐Term Registry is a prospective, observational study conducted in 211 Cardiology Centres of 21 European and Mediterranean countries, members of the European Society of Cardiology (ESC). From May 2011 to April 2013, a total of 12 440 patients were enrolled, 40.5% with acute HF and 59.5% with chronic HF. Intravenous treatments for acute HF were heterogeneously administered, irrespective of guideline recommendations. In chronic HF, with reduced EF, renin–angiotensin system (RAS) blockers, beta‐blockers, and mineralocorticoid antagonists (MRAs) were used in 92.2, 92.7, and 67.0% of patients, respectively. When reasons for non‐adherence were considered, the real rate of undertreatment accounted for 3.2, 2.3, and 5.4% of the cases, respectively. About 30% of patients received the target dosage of these drugs, but a documented reason for not achieving the target dosage was reported in almost two‐thirds of them. The more relevant reasons for non‐implantation of a device, when clinically indicated, were related to doctor uncertainties on the indication, patient refusal, or logistical/cost issues.ConclusionThis pan‐European registry shows that, while in patients with acute HF, a large heterogeneity of treatments exists, drug treatment of chronic HF can be considered largely adherent to recommendations of current guidelines, when the reasons for non‐adherence are taken into account. Observations regarding the real possibility to adhere fully to current guidelines in daily clinical practice should be seriously considered when clinical practice guidelines have to be written.

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Tài liệu tham khảo

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Thông tin xuất bản

European Journal of Heart Failure

Tập 15 Số 10

1173-1184

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