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General practitioners' adherence to chronic heart failure guidelines regarding medication: the GP-HF study

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Abstract

Aims

The adherence to the guidelines for pharmacotherapy of chronic heart failure (HF)-patients improves prognosis. Although general practitioners (GPs) treat the majority of HF-patients, information about GPs’ current guideline adherence and their typical prescription rationales is sparse.

Methods and results

A three-stage study design was employed. In Stage I, 206 patient records from 15 randomly chosen GP practices were analysed; 76 % of patients were prescribed ACE-inhibitors or angiotensin receptor blockers (ACEIs/ARBs), 73 % beta blocker (BBs), but only 18 % mineralocorticoid receptor antagonists (MRAs). ACEI doses were at 62 % of the guideline recommended target doses, BBs at 46 %, while MRAs were sufficiently highly dosed. The guideline adherence indicator (GAI-3) was only 22 %. In Stage II, GPs in all 15 practices were interviewed, and health record documentation deficits and patients’ contraindications were taken into account. This increased the percentage of patients correctly prescribed ACEIs/ARBs to 87 %, BBs to 84 % and GAI-3 to 56 %. MRAs exhibited the most frequent contraindications, but remained underprescribed. Many GPs seemed not to be aware of the therapeutic value of MRAs or the need to reach target doses of the indicated drug classes. Patients—interviewed in Stage III—reported good tolerability of HF-drugs and generally good compliance, although 11 % discontinued HF-medication on their own.

Conclusions

Guideline adherence of GPs was higher than expected from literature and might be further improved by highlighting MRAs as the third prognostically relevant drug class beside ACEIs/ARBs and BBs and stronger emphasis on target doses.

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Abbreviations

ACEI:

Angiotensin-converting-enzyme inhibitor

ARB:

Angiotensin receptor blocker

BB:

Beta-blocker

CAD:

Coronary artery disease

CKD:

Chronic kidney disease

CRT:

Cardiac resynchronization therapy

ESC:

European Society of Cardiology

GP:

General practitioner

HF:

(Chronic) heart failure

HFpEF:

Heart failure with preserved ejection fraction

HFrEF:

Heart failure with reduced ejection fraction

MRA:

Mineralocorticoid receptor antagonist

NYHA:

New York Heart Association Functional Classification of heart failure

RAAS:

Renin–angiotensin–aldosterone system

T/TL:

Thiazide or thiazide-like

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Acknowledgments

We would like to thank all participating GPs, their teams and all participating patients. Further thanks go to Frank Neumann, Gerlinde Raasch, Uta Augustin and Bettina Zippel-Schultz for their great administrative assistance and Annett I. Kröttinger for her kind proofreading assistance.

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Authors and Affiliations

  1. Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Marc N. Hirt, Aljosha Muttardi & Thomas Eschenhagen

  2. DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany

    Marc N. Hirt & Thomas Eschenhagen

  3. German Foundation for the Chronically Ill (DSCK), Fürth, Germany

    Thomas M. Helms

  4. Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    Hendrik van den Bussche

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  1. Marc N. Hirt
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Correspondence to Thomas Eschenhagen.

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Sources of funding

This study was supported by funds from the German Foundation for the Chronically Ill (DSCK), Fürth, Germany.

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None declared.

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Hirt, M.N., Muttardi, A., Helms, T.M. et al. General practitioners' adherence to chronic heart failure guidelines regarding medication: the GP-HF study. Clin Res Cardiol 105, 441–450 (2016). https://doi.org/10.1007/s00392-015-0939-8

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  • DOI: https://doi.org/10.1007/s00392-015-0939-8

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