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Implementation of evidence–based therapy in patients with systolic heart failure from 1998–2000

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Summary

Background

In recent years, the incidence of systolic heart failure has increased. Besides a complete revascularization, guideline–based medication represents the most effective therapeutic approach.

Aim

Analysis of adherence of guideline–recommended and actual medication during inpatient cardiac rehabilitation as well as under subsequent outpatient conditions.

Methods

From 01/1998 to 12/ 2000, 1346 consecutive patients (64 ± 10 years, 73% male, LVEF 36.3 ± 8%, 88% ischemic, 6.7% valvular cardiomyopathy, 5.3% other causes, 11.8% atrial fibrillation) were included in a singlecenter prospective register. Medication was recorded at discharge and after the follow–up period of 731 ± 215 days. Trends in prescription rates were analyzed based on nonparametric correlations (Spearman's–Rho). Changes in medication from in– to outpatient settings were analyzed using exact McNemar test.

Results

At discharge 75.3% (67.9%/68.9%/ 86.6% in 1998/1999/2000, p <0.001) of the patients were treated as recommended. This rate dropped to 68.3% at followup (p <0.0001). Mortality within the follow–up period was low (12.6%).

Conclusion

It could be shown that from 1998 to 2000 inpatient guideline conformity was implementable adequately. Outpatient conformity was significantly lower. Although a high proportion of correctly prescribed CHF medication could be demonstrated, a further effort to improve guideline adherence in the management of heart failure patients is desirable.

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References

  1. American Heart Association (2002) Heart and Stroke Statistical Update. Dallas, Texas. American Heart Association

  2. Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS) (1987) The CONSENSUS Trial Study Group. N Engl J Med 316:1429–1435

    Google Scholar 

  3. Hjalmarson A, Goldstein S, Fagerberg B et al (2000) Effects of controlled–release metoprolol on total mortality, hospitalizations, and well–being in patients with heart failure: theMetoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERITHF). MERIT–HF Study Group. JAMA 283:1295–1302

    Article  CAS  PubMed  Google Scholar 

  4. Bohm M, Maack C, Wehrlen–Grandjean M, Erdmann E (2003) Effect of bisoprolol on perioperative complications in chronic heart failure after surgery (Cardiac Insufficiency Bisoprolol Study II (CIBIS II)). Z Kardiol 92:668–676

    CAS  PubMed  Google Scholar 

  5. Pitt B, Zannad F, Remme WJ et al (1999) The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med 341:709–717

    CAS  PubMed  Google Scholar 

  6. Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ et al (2003) Effects of candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM–Overall programme. Lancet 362:759–766

    CAS  PubMed  Google Scholar 

  7. Hunt SA, Baker DW, Chin MH et al (2001) ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary: a report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee to revise the 1995 Guidelines for the Evaluation and Management of Heart Failure). J Am Coll Cardiol 38:2101–2113

    Article  CAS  PubMed  Google Scholar 

  8. Remme WJ, Swedberg K (2002) European society of cardiology. Comprehensive guidelines for the diagnosis and treatment of chronic heart failure. Task force for the diagnosis and treatment of chronic heart failure of the European Society of Cardiology. Eur J Heart Fail 4:11–22

    PubMed  Google Scholar 

  9. Butler J, Arbogast PG, Daugherty J et al (2004) Outpatient utilization of angiotensin– converting enzyme inhibitors among heart failure patients after hospital discharge. J Am Coll Cardiol 43:2036–2043

    CAS  PubMed  Google Scholar 

  10. Ferreira A, Bettencourt P, Cortez M et al (1997) Angiotensin–converting enzyme inhibitors in heart failure: physicians’ prescribing behavior. J Card Fail 3:295–302

    CAS  PubMed  Google Scholar 

  11. Muntwyler J, Cohen–Solal A, Freemantle N et al (2004) Relation of sex, age and concomitant diseases to drug prescription for heart failure in primary care in Europe. Eur J Heart Fail 6:663–668

    PubMed  Google Scholar 

  12. Faggiano P, Opasich C, Tavazzi L et al (2003) Prescription patterns of diuretics in chronic heart failure: a contemporary background as a clue to their role in treatment. J Card Fail 9:210–218

    PubMed  Google Scholar 

  13. Hoppe UC, Erdmann E (1998) Leitlinien zur Therapie der chronischen Herzinsuffizienz. Im Auftrag der Deutschen Gesellschaft für Kardiologie. Z Kardio 87:645–658

    CAS  Google Scholar 

  14. Feigenbaum H (1994) Echocardiographic evaluation of cardiac chambers. In: Bussy RK (ed) Echocardiography. 5th edition. Philadelphia, Lea & Febiger, pp 138–140

  15. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure (1993) The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Lancet 342:821–828

    Google Scholar 

  16. Hoppe UC, Böhm M, Dietz R, Hanrath P, Kroemer HK et al (2005) Leitlinien zur Therapie der chronischen Herzinsuffizienz. Z Kardiol 94:488– 509

    Article  CAS  PubMed  Google Scholar 

  17. Ceia F, Fonseca C, Mota T, Morais H, Matias F, Costa C, Oliveira AG (2004) Aetiology, comorbidity and drug therapy of chronic heart failure in the real world: the EPICA substudy. Eur J Heart Fail 6:801–806

    PubMed  Google Scholar 

  18. McKee SP, Leslie SJ, LeMaitre JP, Webb DJ, Denvir MA (2003) Management of chronic heart failure due to systolic left ventricular dysfunction by cardiologist and non–cardiologist physicians. Eur J Heart Fail 5:549– 555

    PubMed  Google Scholar 

  19. Komajda M, Lapuerta P, Hermans N, Gonzalez–Juanatey JR, van Veldhuisen DJ et al (2005) Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey. Eur Heart J 26:1653–1659

    Article  PubMed  Google Scholar 

  20. Poole–Wilson PA, Swedberg K, Cleland JG et al (2003) Carvedilol or metoprolol european trial investigators. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the Carvedilol Or Metoprolol European Trial (COMET): randomised controlled trial. Lancet 362:7–13

    CAS  PubMed  Google Scholar 

  21. Gupta R, Tang WH, Young JB (2004) Patterns of beta–blockers utilization in patients with chronic heart failure: experience from a specialized outpatient heart failure clinic. Am Heart J 147:79–83

    Article  CAS  PubMed  Google Scholar 

  22. Drechsler K, Dietz R, Klein H, Wollert KC, Storp D, Molling J, Zeymer U, Niebauer J (2005) Euro heart failure survey Medical treatment not in line with current guidelines. Z Kardiol 94:510–515

    CAS  PubMed  Google Scholar 

  23. Baxter AJ, Spensley A, Hildreth A et al (2002) Beta blockers in older persons with heart failure: tolerability and impact on quality of life. Heart 88:611–614

    Article  CAS  PubMed  Google Scholar 

  24. Gheorghiade M, Adams KF Jr, Colucci WS (2004) Digoxin in the management of cardiovascular disorders. Circulation 109:2959–2964

    Article  PubMed  Google Scholar 

  25. Komajda M, Follath F, Swedberg K et al (2003) Study group on diagnosis of the working group on heart failure of the european society of cardiology. The EuroHeart Failure Survey programme – a survey on the quality of care among patients with heart failure in Europe. Part 2: treatment. Eur Heart J 24:464–474

    CAS  PubMed  Google Scholar 

  26. Feinglass J, Martin GJ, Lin E et al (2003) Is heart failure survival improving? Evidence from 2323 elderly patients hospitalized between 1989– 2000. Am Heart J 146:111–114

    Article  PubMed  Google Scholar 

  27. Majumdar SR, McAlister FA, Cree M, Chang WC, Packer M, Armstrong PW (2004) ATLAS Study Group. Do evidence– based treatments provide incremental benefits to patients with congestive heart failure already receiving angiotensin–converting enzyme inhibitors? A secondary analysis of one–year outcomes from the Assessment of Treatment with Lisinopril and Survival (ATLAS) study. Clin Ther 26:694–703

    Article  CAS  PubMed  Google Scholar 

  28. Stewart S, MacIntyre K, Hole DJ et al (2001) More ‘malignant’ than cancer? Five–year survival following a first admission for heart failure. Eur J Heart Fail 3:315–322

    CAS  PubMed  Google Scholar 

  29. Ho KK, Anderson KM, Kannel WB et al (1993) Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation 88:107–115

    CAS  PubMed  Google Scholar 

  30. Flesch M, Komajda M, Lapuerta P, Hermans N, Le Pen C, Gonzales–Juanatey JR, Van Veldhuisen DJ, Tavazzi L, Poole–Wilson P, Erdmann E (2005) Adherence to guidelines in CHF therapy in Germany. Dtsch Med Wochenschr 130:2191–2197

    Article  CAS  PubMed  Google Scholar 

  31. Miche E, Herrmann G, Wirtz U, Laki H, Barth M et al (2003) Effects of education, self–care instruction and physical exercise on patients with chronic heart failure. Z Kardiol 92:985–993

    Article  CAS  PubMed  Google Scholar 

  32. Cleland JG, Cohen–Solal A, Aguilar JC, Dietz R, Eastaugh J et al (2002) Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey. Lancet 360:1631– 1639

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik am See Ruedersdorf/Berlin, Seebad 84, 15562, Ruedersdorf/Berlin, Germany

    Rona K. Reibis, C. Dovifat, B. Ehrlich, S. Schulz, K. Stolze & H. Völler

  2. Zentralkrankenhaus Reinkenheide, Postbrookstraße 103, 27574, Bremerhaven, Germany

    R. Dissmann

  3. Institute of Statistics and Econometry, University of Hamburg, Von-Melle-Park 5, 20146, Hamburg, Germany

    K. Wegscheider

Authors
  1. Rona K. Reibis
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  2. C. Dovifat
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  3. R. Dissmann
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  4. B. Ehrlich
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  5. S. Schulz
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  6. K. Stolze
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  7. K. Wegscheider
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  8. H. Völler
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Corresponding author

Correspondence to Rona K. Reibis.

Additional information

This study was partly presented at the 53rd Annual Scientific Session of the American College of Cardiology in 2004

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Reibis, R.K., Dovifat, C., Dissmann, R. et al. Implementation of evidence–based therapy in patients with systolic heart failure from 1998–2000. Clin Res Cardiol 95, 154–161 (2006). https://doi.org/10.1007/s00392-006-0348-0

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  • DOI: https://doi.org/10.1007/s00392-006-0348-0

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