Physicians' guideline adherence is associated with long-term heart failure mortality in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry.
AuthorKomajda, M; Schöpe, J; Wagenpfeil, S; Tavazzi, L; Böhm, M; Ponikowski, P; Anker, SD; Filippatos, GS; Cowie, MR; QUALIFY Investigators,
Source TitleEuropean Journal of Heart Failure
University of Melbourne Author/sHare, David
AffiliationMedicine Dentistry & Health Sciences
Document TypeJournal Article
CitationsKomajda, M., Schöpe, J., Wagenpfeil, S., Tavazzi, L., Böhm, M., Ponikowski, P., Anker, S. D., Filippatos, G. S., Cowie, M. R. & QUALIFY Investigators, (2019). 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, 21 (7), pp.921-929. https://doi.org/10.1002/ejhf.1459.
Access StatusOpen Access
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.
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