Dose matters! Optimisation of guideline adherence is associated with lower mortality in stable patients with chronic heart failure

作者：Poelzl G^*; Altenberger J; Pacher R; Ebner C H; Wieser M; Winter A; Fruhwald F; Dornaus C; Ehmsen U; Reiter S; Steinacher R; Huelsmann M; Eder V; Boehmer A; Pilgersdorfer L; Ablasser K; Keroe D; Groebner H; Auer J; Jakl G; Hallas A; Ess M; Ulmer H

来源：International Journal of Cardiology, 2014, 175(1): 83-89.

DOI：10.1016/j.ijcard.2014.04.255

• Chronic heart failure
• Guideline adherence indicator
• Treatment adjustment
• Prognosis

Aims: Guidelines have been published for improving management of chronic heart failure (CHF). We examined the association between improved guideline adherence and risk for all-cause death in patients with stable systolic HF. %26lt;br%26gt;Methods: Data on ambulatory patients (2006-2010) with CHF and reduced ejection fraction (HF-REF) from the Austrian Heart Failure Registry (HIR Austria) were analysed. One-year clinical data and long-term follow-up data until all-cause death or data censoring were available for 1014 patients (age 65 [55-73], male 75%, NYHA class I 14%, NYHA II 56%, NYHA III/IV 30%). A guideline adherence indicator (GAI [0-100%]) was calculated for each patient at baseline and after 12 +/- 3 months that considered indications and contra indications for ACE-I/ARB, beta blockers, and MRA. Patients were considered Delta GAI-positive if GAI improved to or remained at high levels (%26gt;= 80%)Delta GAI50+ positivity was ascribed to patients achieving a dose of %26gt;= 50% of suggested target dose. %26lt;br%26gt;Results: Improvements in GAI and GAI50+ were associated with significant improvements in NYHA class and NT-proBNP (1728 [740-3636] to 970 [405-2348]) (p %26lt; 0.001). Improvements in GAI50+, but not GAI, were independently predictive of lower mortality risk (HR 0.55 [95% CI 0.34-0.87; p=0.01]) after adjustment for a large variety of baseline parameters and hospitalisation for heart failure during follow-up. %26lt;br%26gt;Conclusions: Improvement in guideline adherence with particular emphasis on dose escalation is associated with a decrease in long-term mortality in ambulatory HF-REF subjects surviving one year after registration.

• 出版日期2014-7-15