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Mouquet F, Hugon G, Tindel M, Cohen S, Jourdain P. [Patients insuffisants cardiaques chroniques rarement adressés à un cardiologue libéral ou régulièrement suivis par un médecin généraliste et un cardiologue libéral : étude descriptive transversale (MIRROR-HF)]. Ann Cardiol Angeiol (Paris) 2023; 72:101598. [PMID: 37068350 DOI: 10.1016/j.ancard.2023.101598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/21/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND French health authorities recommend implementing a strong coordination between general practitioners and office-based cardiologists for the care and management of patients with chronic heart failure. The aim of this study was to describe the characteristics of patients with chronic heart failure who were infrequently referred to an office-based cardiologist (either first time referral or last visit more than 12 months before study inclusion) by a general practitioner or other healthcare professional versus those who were regularly followed by a general practitioner and an office-based cardiologist (at least one visit to an office-based cardiologist in the last 12 months). METHODS This was a non-interventional, cross-sectional study, conducted among office-based cardiologists in France during a single study visit. Descriptive statistics were performed. RESULTS 1460 patients were included in the study with 37.1% in the group infrequently referred to an office-based cardiologist and 62.9% in the regularly followed group. The patients who were infrequently referred to an office-based cardiologist had relatively less heart failure with reduced ejection fraction (29.2% versus 36.6%), less prior chronic heart failure hospitalization (15.9% versus 31.4%), and less atrial fibrillation and ischemic heart failure as comorbidities (40.2% versus 50.5% and 39.3% versus 50.1%, respectively) than patients who were regularly followed by an office-based cardiologist and a general practitioner. They also received less clinical exams (25.5% versus 97.4%) and pharmacological (89.3% versus 98.4%) and non-pharmacological (17.3% versus 27.1%) heart failure treatments before the study visit. CONCLUSIONS This study suggested that patients regularly followed by a general practitioner and an office-based cardiologist had globally a more severe chronic heart failure and a better medical monitoring and follow-up than other patients.
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Affiliation(s)
| | | | | | - Serge Cohen
- Hôpital Européen Marseille, Marseille, France
| | - Patrick Jourdain
- Cardiology Department, University Hospital of Bicêtre, Assistance Publique-Hôpitaux de Paris, Kremlin Bicêtre, France
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Aronov A, Kim YJ, Sweiss NJ, Nazir NT. Cardiovascular disease risk evaluation impact in patients with rheumatoid arthritis. Am J Prev Cardiol 2022; 12:100380. [PMID: 36157554 PMCID: PMC9489492 DOI: 10.1016/j.ajpc.2022.100380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/23/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022] Open
Abstract
Although rheumatoid arthritis (RA) results in a 50% increased risk of cardiovascular disease mortality, comparable to the risk associated with diabetes mellitus, a significant care gap remains in cardiovascular risk management for this high-risk population. A retrospective cohort study was conducted at a minority-serving institution to assess demographic, clinical, and laboratory data associated with referral to cardiology by rheumatology. The results showed that a minority (5%) of patients were referred to cardiology during an outpatient rheumatology encounter. Patients referred were more likely to be on antihypertensive medication and aspirin. Differences in traditional cardiovascular risk factors such as systolic blood pressure, LDL cholesterol, smoking history, and diabetes mellitus were not significantly associated with being referred. Patients with RA who were evaluated by cardiology were more likely to be started on cardiovascular risk-reducing medications such as antihypertensive, lipid-lowering, and aspirin therapy. This study highlights a care gap in the evaluation and referral of patients with RA and recognizes the improved preventive cardiovascular care received by patients evaluated by a cardiologist.
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Affiliation(s)
- Avi Aronov
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Yoo Jin Kim
- College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Nadera J Sweiss
- Division of Rheumatology, University of Illinois at Chicago, Chicago, IL, United States
| | - Noreen T. Nazir
- Division of Cardiology, University of Illinois at Chicago, Chicago, IL, United States
- Corresponding author at: University of Illinois at Chicago/UI Health, 840 S Wood Street Suite 920S, Chicago, IL 60612, United States.
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N'cho-Mottoh MPB, Coulibaly I, Koffi F, Angoran I, Bamba-Kamagaté D, Traoré F, Anzouan-Kacou JB. [Do West African cardiologists adhere to the guidelines for the management of heart failure ?]. Ann Cardiol Angeiol (Paris) 2022; 71:208-214. [PMID: 36089414 DOI: 10.1016/j.ancard.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 06/27/2022] [Accepted: 08/17/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Adherence to guidelines for the management of heart failure (HF) has been shown to be a strong predictor of reduced hospitalisations. The aim of this study was therefore to investigate the adherence of West African cardiologists to guidelines for the management of HF. METHODOLOGY This was a prospective cross-sectional multicentric study (Côte d'Ivoire, Togo, Benin and Burkina-Faso). The "ADDress your Heart" survey developed was administered online to assess cardiologists' adherence to the guidelines for the management of heart failure. RESULTS 62.3% of the 106 participants reported that they followed the guidelines closely. The therapeutic classes indicated as first-line by the latest guidelines were insufficiently suggested by physicians: 57.5% for mineralocorticoid receptor antagonists, 41.5% for gliflozins and 30.1% for sacubitril-valsartan In univariate logistic regression, affiliation with a teaching hospital OR [95% CI] = 3.0 [1.3-6.8], p < 0.01 ; access to scientific cardiology journals OR [95 % CI] = 3.4 [1.3-8.9], p = 0.01; and frequent attendance at conferences OR [95% CI]=1.8 [1.2-2.9], p < 0.01, were associated with guideline compliance. These factors persisted in multivariate analysis. CONCLUSION Adherence of West African cardiologists to guidelines on the management of heart failure was moderate. If affiliation to a university hospital is difficult to apply to all cardiologists, access to scientific cardiology journals and frequent attendance in conference should be encouraged.
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Affiliation(s)
| | - Iklo Coulibaly
- Institut de cardiologie d'Abidjan, BPV 206, Abidjan, Côte d'Ivoire
| | - Florent Koffi
- Institut de cardiologie d'Abidjan, BPV 206, Abidjan, Côte d'Ivoire
| | - Inès Angoran
- Institut de cardiologie d'Abidjan, BPV 206, Abidjan, Côte d'Ivoire
| | | | - Fatoumata Traoré
- Institut de cardiologie d'Abidjan, BPV 206, Abidjan, Côte d'Ivoire
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Huitema AA, Daoust A, Anderson K, Poon S, Virani S, White M, Rojas-Fernandez C, Zieroth S, McKelvie RS. Optimal Usage of Sacubitril/Valsartan for the Treatment of Heart Failure: The Importance of Optimizing Heart Failure Care in Canada. CJC Open 2020; 2:321-327. [PMID: 32995716 PMCID: PMC7499363 DOI: 10.1016/j.cjco.2020.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/25/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Heart failure (HF) with reduced ejection fraction represents approximately 50% of the 600,000 Canadians currently living with HF and over 90,000 new cases diagnosed each year. The angiotensin receptor neprilysin inhibitor, sacubitril/valsartan, demonstrated superior efficacy in reducing cardiovascular death and HF hospitalization over standard of care therapy. METHODS The potential magnitude of benefit in Canada with respect to preventing or postponing deaths and reducing hospitalizations resulting from its optimal implementation in patients with HF with an ejection fraction <40% was estimated based on published sources. RESULTS Of the potentially eligible 225,562 patients, this would amount to the prevention of 4699 cardiovascular deaths and first HF hospitalizations, 3698 thirty-day HF readmissions, and 2820 deaths due to all-cause mortality. The number of patients receiving sacubitril/valsartan nationally in 2018 was 27,267. This represents approximately 12% of the calculated eligible population for this therapy in Canada. CONCLUSIONS The findings from this analysis suggest that a substantial number of deaths, hospitalizations, and HF readmissions could potentially be avoided by optimal usage of sacubitril/valsartan therapy in Canada. This emphasizes the importance of rapidly and appropriately implementing evidence-based medications into routine clinical practice, to achieve the best possible outcomes for our patients with HF and to reduce the high burden and cost of HF in Canada.
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Affiliation(s)
- Ashlay A. Huitema
- St Joseph’s Health Care London, London, Ontario, Canada
- Western University, London, Ontario, Canada
| | - Alexia Daoust
- Novartis Pharmaceuticals Canada Inc, Ottawa, Ontario, Canada
| | - Kim Anderson
- Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephanie Poon
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Sean Virani
- Providence Health Care, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michel White
- Montreal Heart Institute, Universite de Montreal, Montreal, Québec, Canada
| | | | - Shelley Zieroth
- St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Robert S. McKelvie
- St Joseph’s Health Care London, London, Ontario, Canada
- Western University, London, Ontario, Canada
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Impact of Individual Patient Profiles on Adherence to Guideline Directed Medical Therapy in Heart Failure With Reduced Ejection Fraction: VCOR-HF Study. Heart Lung Circ 2020; 29:1782-1789. [PMID: 32646638 DOI: 10.1016/j.hlc.2020.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 03/30/2020] [Accepted: 04/30/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Multiple co-morbidities complicate initiation of medical therapy in patients with heart failure with reduced ejection fraction (HFrEF). Adherence to guidelines based on individual patient profiles is not well described. This paper examines the effect of individual patient profiles on guideline recommended therapies for HFrEF. METHODS This was a prospective, observational, non-randomised study of hospitalised HFrEF patients over 30 days, from 2014 to 2017 in 16 hospitals. A previously developed algorithm-based guideline adherence score was used to determine adherence to key performance indicators: prescribing of beta blockers, angiotensin converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), mineralocorticoid-receptor antagonist (MRAs) for HFrEF patients and early outpatient and heart failure (HF) disease management program review. Patients were classified as low, moderate and excellent adherence to medical therapy. RESULTS Of the 696 HFrEF patients, 69.1% (n=481) were male with an average age of 73.15 years (SD±14.5 years). At discharge, 64.6% (n=427) were prescribed an ACEI/ARB, 78.7% (n=525) a beta blocker and 45.3% (n=302) prescribed MRA. Based on individual patient profiles, 18.2% (n=107) of eligible patients received an outpatient clinic and HF disease management program review within 30 days and 41.5% (n=71) were prescribed triple therapy. Based on individual profiles, 13% (n=21) of patients received an excellent guideline adherence score. CONCLUSION Individual patient profiles impact on adherence to guideline recommendations. Review in transitional care and prescribing of triple pharmacotherapy is suboptimal. Translational strategies to facilitate the implementation of guideline recommended therapies is warranted.
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Duraes AR, Filho CRH, de Souza Lima Bitar Y, Neto MG. Heart Failure and Comorbidities—Part 1. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2020. [DOI: 10.1007/s40138-020-00210-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Clinical characteristics, treatment and prognosis of patients with idiopathic dilated cardiomyopathy: a tertiary center experience. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2019; 16:320-328. [PMID: 31105752 PMCID: PMC6503477 DOI: 10.11909/j.issn.1671-5411.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background Contemporary heart failure medications have led to considerable improvement in the survival of patients with heart failure. However, limited evidence is available regarding the effect of those medications in patients with idiopathic dilated cardiomyopathy (IDCM), particularly in China. We sought to analyze the trends in clinical characteristics and the prescription rate of recommended therapies and its prognostic impact in patients with IDCM. Methods From 2009 to 2016, 1441 consecutive patients (age: 55±14 years, 68% men, LVEF: 33% ± 12%) fulfilling World Health Organization criteria for IDCM were enrolled in the current retrospective cohort study. Temporal trends of baseline clinical characteristics, treatment and prognosis were analyzed, and potential influential factors were explored. Results Rates of patients receiving angiotensin-converting enzyme inhibitors/angiotensin II receptors blockers, β-blockers, aldosterone receptor antagonists and diuretics increased from 55%, 45%, 58%, 51% in 2009 to 67%, 69%, 71%, 64% in 2016, respectively (P < 0.05); whereas, the proportion of patients receiving digoxin decreased from 39% in 2009 to 28% in 2016 (P < 0.05). The overall proportion of patients with optimal guideline-directed medical therapy (GDMT) was 44.6%; however, that rate increased from 33% in 2009 to 41%, 49% and 56% in 2012, 2014 and 2016 respectively (P < 0.05). Patients with optimal GDMT had a better outcome than those without, but there was no temporal trend toward improvement in the overall long-term prognosis of IDCM patients with the years. There was a trend towards admission of patients with milder disease and toward increased admission to a cardiology ward with the years. Conclusions An improvement in prescription rates of guideline-recommended medications in IDCM patients was observed. However, it remains suboptimal, and there is still some room for improvement. The prognosis of patients with optimal GDMT was better than those without. Moreover, the following patient category also had an improved prognosis: patients with LVEF ≥ 40%, with device therapy, and those admitted to a cardiology ward.
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Berthelot E, Bauer F, Eicher JC, Flécher E, Gellen B, Guihaire J, Guijarro D, Roul G, Salvat M, Tribouilloy C, Zores F, Lamblin N, de Groote P, Damy T. Pulmonary hypertension in chronic heart failure: definitions, advances, and unanswered issues. ESC Heart Fail 2018; 5:755-763. [PMID: 30030912 PMCID: PMC6165943 DOI: 10.1002/ehf2.12316] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 05/30/2018] [Indexed: 12/05/2022] Open
Abstract
Pulmonary hypertension (PH) is a common and severe complication of heart failure (HF). Consequently, HF is the leading cause of PH. For many years, specialists have attempted to better understand the pathophysiology of PH in HF, to define its prevalence and its impact on prognosis in order to improve the therapeutic management of these patients. Nowadays, despite the recent guidelines published on the subject, several points remain unclear or debated, and until now, no study has demonstrated the efficacy of any treatment. The aim of this review is to report the evolution of the concepts on post‐capillary PH (diagnosis, prevalence, prognosis, and therapeutics). The main issues are raised, focusing especially on the link between structural alterations and haemodynamic abnormalities, to discuss the possible reasons for treatment failures and future potential targets.
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Affiliation(s)
- Emmanuelle Berthelot
- University of Paris Sud, Le Kremlin-Bicêtre, France.,Service de Cardiologie, Pôle Thorax, Hôpital Bicêtre, AP-HP, 78 rue du Général Leclerc, 94275, Le Kremlin-Bicêtre Cedex, France
| | - Fabrice Bauer
- Department of Cardiology, Inserm U1096, Rouen University Hospital, 76031, Rouen, France
| | - Jean-Christophe Eicher
- Department of Cardiology, Dijon University Hospital, 14 rue Paul Gaffarel, 21000, Dijon, France
| | - Erwan Flécher
- Department of Thoracic and Cardiovascular Surgery, Rennes University Hospital, Rennes, France.,Research Unit, Inserm U1099, University of Rennes 1, Rennes, France
| | - Barnabas Gellen
- ELSAN, Polyclinique de Poitiers, 1 rue de la Providence, 86035, Poitiers Cedex, France
| | - Julien Guihaire
- Cardiothoracic Surgery, Marie Lannelongue Hospital I, University of Paris Sud, 133 avenue de la résistance, 92350, Le Plessis Robinson, France
| | - Damien Guijarro
- Institut Cardio-Vasculaire, Groupement Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Gérald Roul
- Faculté de Médecine, Université de Strasbourg, 4 rue Kirschleger, 67085, Strasbourg Cedex, France
| | - Muriel Salvat
- Pôle thorax et vaisseaux, CHU Grenoble Alpes, La Tronche, France
| | - Christophe Tribouilloy
- Department of Cardiology, Amiens University Hospital, Amiens, France.,Inserm U-1088, Jules Verne University of Picardie, Amiens, France
| | | | - Nicolas Lamblin
- University of Lille, Service de CHU Lille, Institut Pasteur de Lille, Inserm U1167, F-59000, Lille, France
| | - Pascal de Groote
- CHU Lille, Service de Cardiologie, F-59000, Lille, France.,Inserm U1167, Institut Pasteur de Lille, F-59000, Lille, France
| | - Thibaud Damy
- Henry Mondor Hospital, Department of Cardiology, Heart Failure and Amyloidosis Unit, Inserm/UPEC: U955, GRC Amyloid Research Institute, 51 Avenue Maréchal de Lattre de Tassigny, 94000, Créteil, France
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Bhat S, Kansal M, Kondos GT, Groo V. Outcomes of a Pharmacist-Managed Heart Failure Medication Titration Assistance Clinic. Ann Pharmacother 2018; 52:724-732. [DOI: 10.1177/1060028018760568] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: National guidelines recommend angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs) and β-blockers (BBs) at target doses for morbidity and mortality benefits in heart failure with reduced ejection fraction (HFrEF); regardless, titration of these therapies in practice remains suboptimal. We implemented an outpatient pharmacist-managed HFrEF medication titration assistance clinic (MTAC) at one institution to improve titration for general cardiology (GC) patients. Objective: To evaluate MTAC impact by determining the proportion of patients on target or maximum tolerated ACE inhibitor/ARB and BB doses. Methods: A retrospective chart review of adult patients with documented ejection fraction ≤40% managed in the MTAC or GC from 2011 to 2013 was conducted. HFrEF medication regimens were collected at initial visit and months 1, 2, 3, 6, 9, and 12 to assess titration. Target doses were defined per guideline or dose at which ejection fraction recovered during the study. Maximum tolerated doses were defined as the highest dose patients tolerated without physiological limitations. Results: Of 148 patients, the MTAC managed 51 and GC managed 97. At baseline, 90% of MTAC versus 82% of GC patients were prescribed ACE inhibitors/ARBs and BBs. In the MTAC, 4% were at target or maximum tolerated doses compared with 32% of GC patients ( P < 0.001). At 12 months, 95% of patients in the MTAC and 87% in GC were prescribed ACE inhibitors/ARBs and BBs. Of those prescribed ACE inhibitors/ARBs and BBs, 64% in the MTAC versus 40% in GC reached target or maximum tolerated doses ( P = 0.01). Conclusions: The pharmacist-managed MTAC increased the proportion of patients on optimal HFrEF therapies and are a resource for GC patients.
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Affiliation(s)
- Shubha Bhat
- Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, CO, USA
| | | | | | - Vicki Groo
- University of Illinois at Chicago, Chicago, IL, USA
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The treatment gap in patients with chronic systolic heart failure: a systematic review of evidence-based prescribing in practice. Heart Fail Rev 2018; 21:675-697. [PMID: 27465132 DOI: 10.1007/s10741-016-9575-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The extent and impact of under-prescribing of evidence-based pharmacological therapies among heart failure patients with reduced ejection fraction (HFREF) in contemporary practice is unclear. We sought to examine the prescribing patterns of angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), β-blockers (BBs) and mineralocorticoid receptor antagonists (MRAs), and to quantify the estimated 'treatment gap' among HFREF patients in the 'real-world' setting. The MEDLINE, PubMed, EMBASE, CINAHL and CENTRAL databases were searched for registry- or survey-based studies which examined the prescribing rates of ACE inhibitors, ARBs, BBs and MRAs among HFREF patients. Searches were limited to those published in the years 2000-2015. A total of 23 reports, including 83,605 patients, were evaluated. Overall, ACE inhibitors/ARBs, BBs and MRAs were prescribed to 79.8, 81.4 and 36.4 % of patients, respectively. The estimated treatment gaps in the overall population were 13.1 % for ACE inhibitors/ARBs, 3.9 % for BBs and 16.8 % for MRAs. The proportion of patients who received ≥50 % of the guideline-recommended target doses was 72 % for ACE inhibitors, 51 % for ARBs, 49 % for BBs, 53 % for the combination of ACE inhibitors/ARBs and BBs and 83 % for MRAs. Prescribing these drugs according to contemporary guidelines was associated with lower mortality risk. Patients who were elderly, female and with comorbidities were less likely to receive optimal treatment as recommended by the guidelines. ACE inhibitors, ARBs, BBs and MRAs are under-prescribed in eligible HFREF patients. Efforts should be made to improve approaches to closing the treatment gap at both systems of care and individual levels.
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Giezeman M, Arne M, Theander K. Adherence to guidelines in patients with chronic heart failure in primary health care. Scand J Prim Health Care 2017; 35:336-343. [PMID: 29105550 PMCID: PMC5730031 DOI: 10.1080/02813432.2017.1397253] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To describe adherence to international guidelines for chronic heart failure (CHF) management concerning diagnostics, pharmacological treatment and self-care behaviour in primary health care. DESIGN A cross-sectional descriptive study of patients with CHF, using data obtained from medical records and a postal questionnaire. SETTING Three primary health care centres in Sweden. SUBJECTS Patients with a CHF diagnosis registered in their medical record. MAIN OUTCOME MEASURES Adherence to recommended diagnostic tests and pharmacological treatment by the European Society of Cardiology guidelines and self-care behaviour, using the European Heart Failure Self-care Behaviour Scale (EHFScBS-9). RESULTS The 155 participating patients had a mean age of 79 (SD9) years and 89 (57%) were male. An ECG was performed in all participants, 135 (87%) had their NT-proBNP measured, and 127 (82%) had transthoracic echocardiography performed. An inhibitor of the renin angiotensin system (RAS) was prescribed in 120 (78%) patients, however only 45 (29%) in target dose. More men than women were prescribed RAS-inhibition. Beta blockers (BBs) were prescribed in 117 (76%) patients, with 28 (18%) at target dose. Mineralocorticoidreceptor antagonists were prescribed in 54 (35%) patients and daily diuretics in 96 (62%). The recommended combination of RAS-inhibitors and BBs was prescribed to 92 (59%), but only 14 (9%) at target dose. The mean score on the EHFScBS-9 was 29 (SD 6) with the lowest adherence to daily weighing and consulting behaviour. CONCLUSION Adherence to guidelines has improved since prior studies but is still suboptimal particularly with regards to medication dosage. There is also room for improvement in patient education and self-care behaviour.
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Affiliation(s)
- Maaike Giezeman
- School of Medical Sciences, Örebro University, Örebro, Sweden
- Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden
- CONTACT Maaike Giezeman Centre for Clinical Research, Hus 73 plan 3, 65185 Karlstad, Sweden
| | - Mats Arne
- Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden
- Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Kersti Theander
- Centre for Clinical Research, County Council of Värmland, Karlstad, Sweden
- Department of Nursing, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden
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Gap Between Clinical Practice and Guidelines: A National Survey of the Knowledge of Recommended Heart Failure Guidelines Among Chinese Physicians. Qual Manag Health Care 2017; 26:196-204. [PMID: 28991815 DOI: 10.1097/qmh.0000000000000150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We investigated the current level of knowledge of Chinese heart failure (HF) guidelines among physicians, as a reference for the promotion and transformation of HF knowledge. METHODS AND RESULTS Physicians from 88 hospitals in 27 provinces of China completed our survey between July and December 2014. The questions covered the main points included in the Chinese HF diagnosis and treatment guidelines (2014). A total of 2146 physicians, aged 20 to 62 years (35.6 ± 7.6 years), completed the survey. The correctness rate of their answers to the 15 multiple-choice questions in the HF questionnaire was generally low (mean 32.6%). The mean correctness rate for 10 blank-filling questions about the target doses of angiotensin-converting enzyme inhibitors, angiotensin II receptor antagonists, and β-blockers was 42.5%. On the basis of their responses, physicians whose knowledge of the guidelines was "excellent," "good," "medium," and "bad" accounted for 1.1%, 11.4%, 14.2%, and 73.4%, respectively. Physicians who possessed a higher level of qualifications had significantly greater awareness of HF guidelines than those with relatively low qualifications (P < .001). A statistically significant association was found between hospital level and adherence to treatment guidelines (P < .001). A significant difference was also observed among physicians in different practice scopes (P < .001). CONCLUSIONS The survey found an obvious deficiency in physicians' mastery of fundamental knowledge about HF. There is a need to improve physicians' education about HF in China.
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Morbach C, Wagner M, Güntner S, Malsch C, Oezkur M, Wood D, Kotseva K, Leyh R, Ertl G, Karmann W, Heuschmann PU, Störk S. Heart failure in patients with coronary heart disease: Prevalence, characteristics and guideline implementation - Results from the German EuroAspire IV cohort. BMC Cardiovasc Disord 2017; 17:108. [PMID: 28476146 PMCID: PMC5420109 DOI: 10.1186/s12872-017-0543-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 04/28/2017] [Indexed: 01/10/2023] Open
Abstract
Background Adherence to pharmacotherapeutic treatment guidelines in patients with heart failure (HF) is of major prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Our aim was to investigate prevalence and characteristics of HF in patients with coronary heart disease (CHD), and to assess the adherence to current HF guidelines in patients with HF stage C, thus identifying potential targets for the optimization of guideline implementation. Methods Patients from the German sample of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EuroAspire) IV survey with a hospitalization for CHD within the previous six to 36 months providing valid data on echocardiography as well as on signs and symptoms of HF were categorized into stages of HF: A, prevalence of risk factors for developing HF; B, asymptomatic but with structural heart disease; C, symptomatic HF. A Guideline Adherence Indicator (GAI-3) was calculated for patients with reduced (≤40%) left ventricular ejection fraction (HFrEF) as number of drugs taken per number of drugs indicated; beta-blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, and mineralocorticoid receptor antagonists (MRA) were considered. Results 509/536 patients entered analysis. HF stage A was prevalent in n = 20 (3.9%), stage B in n = 264 (51.9%), and stage C in n = 225 (44.2%) patients; 94/225 patients were diagnosed with HFrEF (42%). Stage C patients were older, had a longer duration of CHD, and a higher prevalence of arterial hypertension. Awareness of pre-diagnosed HF was low (19%). Overall GAI-3 of HFrEF patients was 96.4% with a trend towards lower GAI-3 in patients with lower LVEF due to less thorough MRA prescription. Conclusions In our sample of CHD patients, prevalence of HF stage C was high and a sizable subgroup suffered from HFrEF. Overall, pharmacotherapy was fairly well implemented in HFrEF patients, although somewhat worse in patients with more reduced ejection fraction. Two major targets were identified possibly suited to further improve the implementation of HF guidelines: 1) increase patients´ awareness of diagnosis and importance of HF; and 2) disseminate knowledge about the importance of appropriately implementing the use of mineralocorticoid receptor antagonists. Trial registration This is a cross-sectional analysis of a non-interventional study. Therefore, it was not registered as an interventional trial.
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Affiliation(s)
- Caroline Morbach
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Department of Medicine I, University Hospital of Würzburg, Wuerzburg, Germany
| | - Martin Wagner
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Wuerzburg, Germany
| | - Stefan Güntner
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Department of Medicine I, University Hospital of Würzburg, Wuerzburg, Germany
| | - Carolin Malsch
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Wuerzburg, Germany
| | - Mehmet Oezkur
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Department of Cardiovascular Surgery, University Hospital Würzburg, Wuerzburg, Germany
| | - David Wood
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK
| | - Kornelia Kotseva
- Department of Cardiovascular Medicine, National Heart and Lung Institute, Imperial College London, London, UK.,Department of Public Health, University of Ghent, Ghent, Belgium
| | - Rainer Leyh
- Department of Cardiovascular Surgery, University Hospital Würzburg, Wuerzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Department of Medicine I, University Hospital of Würzburg, Wuerzburg, Germany
| | - Wolfgang Karmann
- Department of Medicine, Klinik Kitzinger Land, Kitzingen, Germany
| | - Peter U Heuschmann
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany.,Institute of Clinical Epidemiology and Biometry, University of Würzburg, Wuerzburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, Am Schwarzenberg 15, 97078, Wuerzburg, Germany. .,Department of Medicine I, University Hospital of Würzburg, Wuerzburg, Germany.
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14
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Komajda M, Cowie MR, Tavazzi L, Ponikowski P, Anker SD, Filippatos GS. Physicians' guideline adherence is associated with better prognosis in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry. Eur J Heart Fail 2017; 19:1414-1423. [DOI: 10.1002/ejhf.887] [Citation(s) in RCA: 146] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 04/14/2017] [Accepted: 04/17/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Michel Komajda
- Institute of Cardiometabolism and Nutrition (ICAN); Pierre et Marie Curie University, Paris VI, La Pitié-Salpétrière Hospital; Paris France
| | | | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research, Ettore Sansavini Health Science Foundation; Cotignola Italy
| | | | - Stefan D. Anker
- Innovative Clinical Trials, Department of Cardiology and Pneumology; University Medical Center Göttingen (UMG); Göttingen Germany
| | - Gerasimos S. Filippatos
- National and Kapodistrian University of Athens, School of Medicine; Athens University Hospital Attikon; Athens Greece
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15
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Cowie MR, Komajda M. Quality of Physician Adherence to Guideline Recommendations for Life-saving Treatment in Heart Failure: an International Survey. Card Fail Rev 2017; 3:130-133. [PMID: 29387466 DOI: 10.15420/cfr.2017:13:1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
QUALIFY (QUality of Adherence to guideline recommendations for LIFe-saving treatment in heart failure surveY) showed that good physician adherence to guideline recommendations for angiotensin converting enzyme inhibitors/angiotensin receptor blockers, beta blockers, mineralocorticoid receptor antagonists and ivabradine, with prescription of at least 50 % of recommended dosages, was associated with better 6-month outcomes than moderate or poor adherence. Poor adherence was associated with higher all-cause mortality (hazard ratio 2.21; 95 % CI [1.42-3.44]; p=0.001) and combined heart failure hospitalisation or death (hazard ratio 1.26; 95 % CI [1.08-1.71]; p=0.024) compared with good adherence. Heart failure hospitalisation is a good opportunity to review a patient's medication and to optimise guideline adherence.
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Affiliation(s)
- Martin R Cowie
- Imperial College London (Royal Brompton Hospital),London, UK and Institute of Cardiology, Pitie-Salpetriere Hospital Group,Paris, France
| | - Michel Komajda
- Imperial College London (Royal Brompton Hospital),London, UK and Institute of Cardiology, Pitie-Salpetriere Hospital Group,Paris, France
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16
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Komajda M, Anker SD, Cowie MR, Filippatos GS, Mengelle B, Ponikowski P, Tavazzi L. Physicians' adherence to guideline-recommended medications in heart failure with reduced ejection fraction: data from the QUALIFY global survey. Eur J Heart Fail 2016; 18:514-22. [DOI: 10.1002/ejhf.510] [Citation(s) in RCA: 152] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/01/2015] [Accepted: 12/05/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Michel Komajda
- Institute of Cardiometabolism and Nutrition (ICAN); Pierre & Marie Curie Paris VI University, La Pitié-Salpétrière Hospital; AP-HP, 47-83 Boulevard de l'Hôpital 75013 Paris France
| | - Stefan D. Anker
- Innovative Clinical Trials, Department of Cardiology & Pneumology; University Medical Centre Göttingen (UMG); Göttingen Germany
| | | | | | | | | | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care & Research; Ettore Sansavini Health Science Foundation; Cotignola Italy
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17
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General practitioners' adherence to chronic heart failure guidelines regarding medication: the GP-HF study. Clin Res Cardiol 2015; 105:441-50. [DOI: 10.1007/s00392-015-0939-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
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18
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Baudouin C, Groshens S, Gueneau P, Rousseau M, Saura M, Hryschyschyn N, Hillani A, Dagorn J, Pitthan E, Jourdain P. [Medico-economic impact of an innovative management of CHF by HF unit]. Ann Cardiol Angeiol (Paris) 2015; 64:318-324. [PMID: 26482635 DOI: 10.1016/j.ancard.2015.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 09/03/2015] [Indexed: 06/05/2023]
Abstract
Chronic heart failure remains a frequent, severe and costly disease. Despite encouraging data from different countries, heart failure clinics are scarce in France. We have analyzed the impact of a heart failure clinic (UTIC of Pontoise) in terms of reduction of rehospitalizations and in hospitalization costs in 4855 consecutive patients. In our study, heart failure clinic management dramatically reduces HF related hospitalizations (RRR: -28 %, P=0.001) and HF related costs (55% reduction, P<0.001) regardless of comorbidities or disease severity. HF clinics have to be developed in France in order to optimize management of CHF and reduce the HF related costs.
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Affiliation(s)
- C Baudouin
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | | | - P Gueneau
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - M Rousseau
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - M Saura
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - N Hryschyschyn
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - A Hillani
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - J Dagorn
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France
| | - E Pitthan
- Instituto de Cardiologia, Porto Alegre, RS, 90040-371, Brésil
| | - P Jourdain
- Unité thérapeutique d'insuffisance cardiaque, CHR Dubos, 6, avenue de l'Île-de-France, 95300 Pontoise, France.
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19
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Gabet A, Juillière Y, Lamarche-Vadel A, Vernay M, Olié V. National trends in rate of patients hospitalized for heart failure and heart failure mortality in France, 2000-2012. Eur J Heart Fail 2015; 17:583-90. [DOI: 10.1002/ejhf.284] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/25/2015] [Accepted: 04/09/2015] [Indexed: 11/07/2022] Open
Affiliation(s)
- Amélie Gabet
- Department of Chronic Diseases and Injuries; French Institute for Public Health Surveillance; Saint Maurice France
| | - Yves Juillière
- Department of Cardiology; Nancy University Hospital; Vandoeuvre-lès-Nancy France
| | - Agathe Lamarche-Vadel
- National Institute of Health and Medical Research (INSERM); French Epidemiology Center on medical causes of death (CépiDc); Le Kremlin-Bicêtre France
| | - Michel Vernay
- Department of Chronic Diseases and Injuries; French Institute for Public Health Surveillance; Saint Maurice France
| | - Valérie Olié
- Department of Chronic Diseases and Injuries; French Institute for Public Health Surveillance; Saint Maurice France
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20
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Böhm M, Tschöpe C, Wirtz JH, Lokies J, Turgonyi E, Bramlage P, Lins K, Strunz AM, Tebbe U. Treatment of heart failure in real-world clinical practice: findings from the REFLECT-HF registry in patients with NYHA class II symptoms and a reduced ejection fraction. Clin Cardiol 2015; 38:200-7. [PMID: 25733185 DOI: 10.1002/clc.22375] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 11/18/2014] [Accepted: 11/22/2014] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Optimal medical therapy (OMT) for patients with chronic heart failure and a reduced ejection fraction (HF-REF) includes angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, and mineralocorticoid receptor antagonists, plus a diuretic. HYPOTHESIS We hypothesized that OMT is less often prescribed in HF-REF patients (≤35%) with New York Heart Association (NYHA) class II symptoms compared with those with NYHA class III/IV symptoms. METHODS This was a cross-sectional, observational, multicenter survey of hospital-based cardiologists, office-based cardiologists, and general practitioners in Germany. RESULTS Out of a total of 384 patients enrolled, 144 had REF ≤35%. Patients with REF had NYHA class II symptoms in 39.6% (n = 57) and NYHA class III/IV symptoms in 60.4% (n = 87). The REF/NYHA class II group had a higher proportion of males than the REF/NYHA class III/IV group. For angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and β-blockers, prescription rates were high and comparable between groups. However, prescription rates for mineralocorticoid receptor antagonists were lower compared with other guideline-recommended treatments. Multivariate analyses indicated that OMT prescription was reduced for older patients and increased for patients cared for by an office-based cardiologist. CONCLUSIONS Given the high proportion of patients with reduced left ventricular systolic function but only minor symptoms, HF-REF appears to be underdiagnosed, and a higher proportion of patients than are currently recognized could potentially be candidates for OMT.
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Affiliation(s)
- Michael Böhm
- Internal Medicine Clinic III, Saarland University Medical Center, Homburg/Saar, Germany
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21
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Dokainish H, Jewett L, Nieuwlaat R, Coulson J, Demers C, Lonn E, Healey J, Haynes B, Connolly S. Gaps in Medical and Device Therapy for Patients with Left Ventricular Systolic Dysfunction: The EchoGap Study. Open Cardiovasc Med J 2014; 8:94-101. [PMID: 25343000 PMCID: PMC4205776 DOI: 10.2174/1874192401408010094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/25/2014] [Accepted: 08/28/2014] [Indexed: 11/22/2022] Open
Abstract
Objectives: To assess gaps between guidelines and medicine prescription/dosing and referral for defibrillator therapy in patients with left ventricular systolic dysfunction (LVSD). Methods: Outpatient echocardiography reports at an academic hospital centre were screened and outpatients with LVEF<40% were included. A questionnaire was mailed to the patients’ physician, querying prescription/dosing of ACE-inhibitors (ACEi), angiotensin receptor blockers (ARB) and beta-blockers (BB). Patients with LVEF<30% had additional questions on implantable cardiac defibrillator (ICD) referral. Results: Mean age was 69.6+/-12.2 years and mean LVEF was 29.7+/-6.5%. ACEi and/or ARB prescription rate was 260/309(84.1%) versus 256/308(83.1%) for BB (p=NS for comparison). Of patients on ACEi, 77/183(42.1%) were on target dose, compared to 7/45(15.5%) for ARB and 9/254(3.5%) for BB (p<0.01). Of 171/309 patients (55.3%) with LVEF<30%, 72/171(42.1%) had an ICD and 16/171(9.4%) were referred for one. Conclusion: Prescription rates of evidence-based HF medicines are relatively high in outpatients with LVSD referred for echocardiography at this Canadian academic medical centre; however, the proportion of patients at target doses was modest for ACEi and low for ARB and BB. Approximately half of patients who qualify for ICD by EF alone have one or were referred. Important reasons for patients with LVSD not on evidence-based therapy were identified.
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Affiliation(s)
- Hisham Dokainish
- Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Lauren Jewett
- Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Robby Nieuwlaat
- Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Joshua Coulson
- Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Catherine Demers
- Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Eva Lonn
- Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Jeff Healey
- Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Brian Haynes
- Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Stuart Connolly
- Division of Cardiology, Department of Medicine and the Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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22
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Dose matters! Optimisation of guideline adherence is associated with lower mortality in stable patients with chronic heart failure. Int J Cardiol 2014; 175:83-9. [PMID: 24857326 DOI: 10.1016/j.ijcard.2014.04.255] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 04/16/2014] [Accepted: 04/23/2014] [Indexed: 01/12/2023]
Abstract
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. 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 contraindications for ACE-I/ARB, beta blockers, and MRA. Patients were considered ΔGAI-positive if GAI improved to or remained at high levels (≥ 80%). ΔGAI50+ positivity was ascribed to patients achieving a dose of ≥ 50% of suggested target dose. 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<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. 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.
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23
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Tuppin P, Cuerq A, de Peretti C, Fagot-Campagna A, Danchin N, Juillière Y, Alla F, Allemand H, Bauters C, Drici MD, Hagège A, Jondeau G, Jourdain P, Leizorovicz A, Paccaud F. Two-year outcome of patients after a first hospitalization for heart failure: A national observational study. Arch Cardiovasc Dis 2014; 107:158-68. [DOI: 10.1016/j.acvd.2014.01.012] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 01/20/2014] [Accepted: 01/30/2014] [Indexed: 11/26/2022]
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24
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McIntyre HF. Leveraging guidelines: understanding heart failure, organizing care. Commentary on the 2010 NICE chronic heart failure guideline update. Eur J Heart Fail 2014; 13:14-7. [DOI: 10.1093/eurjhf/hfq201] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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El-Menyar AA. Multidisciplinary approach for circulatory support in patients with advanced heart failure. Expert Rev Cardiovasc Ther 2014; 7:259-62. [DOI: 10.1586/14779072.7.3.259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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26
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Juillière Y, Suty-Selton C, Riant E, Darracq JP, Dellinger A, Labarre JP, Druelle J, Mulak G, Danchin N, Jourdain P. Prescription of cardiovascular drugs in the French ODIN cohort of heart failure patients according to age and type of chronic heart failure. Arch Cardiovasc Dis 2014; 107:21-32. [DOI: 10.1016/j.acvd.2013.11.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 11/21/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
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27
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Kaplan A, Gruffydd-Jones K, van Gemert F, Kirenga BJ, Medford ARL. A woman with breathlessness: a practical approach to diagnosis and management. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2013; 22:468-76. [PMID: 24270362 PMCID: PMC6442845 DOI: 10.4104/pcrj.2013.00100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 10/26/2013] [Indexed: 02/05/2023]
Abstract
Worsening breathless in a patient with severe chronic obstructive pulmonary disease (COPD) is a common diagnostic and management challenge in primary care. A systematic approach to history-taking and examination combined with targeted investigation of pulmonary, cardiovascular, thromboembolic and systemic causes is essential if co-morbidities are to be identified and managed. Distinguishing between heart failure and COPD is a particular challenge as symptoms and signs overlap. In low and middle income countries additional priorities are the detection of infections such as tuberculosis and human immunodeficiency virus (HIV). Clinicians need to be alert to the possibility of atypical presentations (such as pain-free variants of angina) and less common conditions (including chronic thromboembolic pulmonary hypertension) in order not to overlook important potentially treatable conditions.
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Affiliation(s)
- Alan Kaplan
- Family Physician Airways Group of Canada, Richmond Hill, Ontario, Canada
| | | | - Frederik van Gemert
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bruce J Kirenga
- Department of Medicine, School of Medicine, Makerere University, Kampala, Uganda
| | - Andrew RL Medford
- Consultant & Honorary Senior Lecturer in Thoracic Medicine & Interventional Pulmonology, North Bristol Lung Centre & University of Bristol, Southmead Hospital, Bristol, UK
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28
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Tuppin P, Cuerq A, de Peretti C, Fagot-Campagna A, Danchin N, Juillière Y, Alla F, Allemand H, Bauters C, Drici MD, Hagège A, Jondeau G, Jourdain P, Leizorovicz A, Paccaud F. First hospitalization for heart failure in France in 2009: Patient characteristics and 30-day follow-up. Arch Cardiovasc Dis 2013; 106:570-85. [DOI: 10.1016/j.acvd.2013.08.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Revised: 07/05/2013] [Accepted: 08/20/2013] [Indexed: 01/30/2023]
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29
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Koifman E, Kopel E, Maor E, Fefer P, Matezky S, Tofler G, Hamdan A, Grossman E, Goldenberg I, Klempfner R. Mineralocorticoid receptor antagonist use in eligible patients following acute myocardial infarction: Real world data from the Acute Coronary Syndrome Israeli Surveys: 2004–2010. Int J Cardiol 2013; 168:3971-6. [DOI: 10.1016/j.ijcard.2013.06.091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Revised: 05/21/2013] [Accepted: 06/30/2013] [Indexed: 10/26/2022]
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30
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B-type Natriuretic Peptide-guided Chronic Heart Failure Therapy: A Meta-analysis of 11 Randomised Controlled Trials. Heart Lung Circ 2013; 22:852-60. [DOI: 10.1016/j.hlc.2013.03.077] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 03/02/2013] [Accepted: 03/14/2013] [Indexed: 11/24/2022]
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31
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The comorbidity conundrum: a focus on the role of noncardiovascular chronic conditions in the heart failure patient. Curr Cardiol Rep 2012; 14:276-84. [PMID: 22415397 DOI: 10.1007/s11886-012-0259-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The rapid aging of the US population combined with improvements in modern medicine has created a new public health concern of comorbidity, a chronic condition that co-exists with a primary illness. Over 141 million Americans suffer from one or more comorbid conditions. In the heart failure (HF) patient, this comorbidity burden is particularly high, with over 40% of patients having five or more chronic conditions. These comorbidities can vary from being a risk factor to a cause of HF progression or even a precipitating factor for decompensation. Comorbidities, particularly the noncardiovascular conditions, have been associated with greater health resource utilization, poor health outcomes, and increased mortality. To minimize the negative impact that these comorbidities have on patient outcomes, appropriate attention should be paid to identifying, prioritizing, and managing each condition; minimizing medication complexity and polypharmacy; and improving overall coordination of care between providers and patients.
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32
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Hawkins NM, Scholes S, Bajekal M, Love H, O'Flaherty M, Raine R, Capewell S. Community care in England: reducing socioeconomic inequalities in heart failure. Circulation 2012; 126:1050-7. [PMID: 22837162 DOI: 10.1161/circulationaha.111.088047] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Socioeconomic deprivation is associated with increased heart failure (HF) incidence, hospitalization rates, and mortality. However, whether the delivery of survival-enhancing medical therapy is equitable remains uncertain. We examined secular trends in the uptake of key medical therapies (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, β-blockers, spironolactone) stratified by socioeconomic circumstances in patients with HF. Secondary analyses examined trends in HF incidence, prevalence, and survival. METHODS AND RESULTS This study was a cross-sectional observational analysis of nationally representative primary care data from England. Treatments for patients with HF in 1999 and 2007 (n=13 330) were extracted from the General Practice Research Database. Socioeconomic circumstances were defined with the Index of Multiple Deprivation 2007, a weighted composite of 7 area-level deprivation domains. Treatment uptake estimates were age standardized. The incidence and prevalence of HF decreased year to year. Although clear socioeconomic gradients in both the incidence and prevalence of HF were apparent, the absolute difference between most and least deprived reduced over time. Uptake of therapies improved over time in both men and women. Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker uptake increased from 46% to 64%, β-blocker uptake from 12% to 41%, and spironolactone uptake from 3% to 20%. Modest age and sex inequalities were apparent. However, no consistent socioeconomic gradients were observed in either treatment or case fatality. CONCLUSIONS Socioeconomic gradients in the incidence and prevalence of HF are reducing. Treatment is generally equitable and independent of socioeconomic circumstances. Most important, no significant inequality in outcomes was apparent. Future strategies should continue to address inequalities in the underlying causes of HF and to increase overall treatment levels further.
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Affiliation(s)
- Nathaniel M Hawkins
- Institute of Cardiovascular Medicine and Sciences, Liverpool Heart and Chest Hospital, Thomas Dr., Liverpool, UK.
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Cohen Solal A, Leurs I, Assyag P, Beauvais F, Clerson P, Contre C, Thebaut JF, Genoun M. Optimization of heart FailUre medical Treatment after hospital discharge according to left ventricUlaR Ejection fraction: The FUTURE survey. Arch Cardiovasc Dis 2012; 105:355-65. [DOI: 10.1016/j.acvd.2012.04.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Revised: 04/14/2012] [Accepted: 04/19/2012] [Indexed: 11/28/2022]
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Vemmos K, Ntaios G, Savvari P, Vemmou AM, Koroboki E, Manios E, Kounali A, Lip GYH. Stroke aetiology and predictors of outcome in patients with heart failure and acute stroke: a 10-year follow-up study. Eur J Heart Fail 2011; 14:211-8. [PMID: 22200911 DOI: 10.1093/eurjhf/hfr172] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS The aim of this study was to investigate stroke aetiology and assess the predictors of early and late outcome in patients with heart failure (HF) and acute stroke. METHODS AND RESULTS A total of 2904 patients, admitted between 1993 and 2010, were regularly followed up at months 1, 3, and 6, and yearly thereafter up to 10 years. There were 283 (9.7%) stroke patients with HF; atrial fibrillation (AF) was present in 144 (50.9%) of them. Stroke aetiology in patients with HF and AF was mainly cardioembolism (82%) regardless of HF aetiology. In contrast, in the 139 non-AF patients with HF, the stroke mechanism was associated with the aetiology of HF: valvular heart disease and dilated cardiomyopathy were related to cardioembolism in 60% and 66.7% of patients, respectively, whereas HF due to coronary artery disease or hypertension was associated with atherosclerotic and lacunar stroke in 40.8% and 61.5%, respectively. In the overall population, HF was an independent predictor of 10-year mortality [hazard ratio = 1.54, 95% confidence interval (CI) 1.29-1.83; P < 0.001]. Probability of 10-year survival was 19.4% (95% CI 14.5-23.5) for HF patients and 44.1% (95% CI 41.4-46.8) for non-HF patients (P < 0.0001). Ten-year mortality in HF patients was associated with functional class of HF, age, diabetes, stroke severity, and in-hospital aspirin use. The presence of AF in HF stroke patients did not influence 10-year survival and composite cardiovascular events (P = 0.429 and P = 0.406, respectively). CONCLUSIONS In patients with HF, stroke aetiology is influenced by the presence of AF and the underlying cause of HF. Early and late stroke outcome is associated with HF severity but not with the presence of AF.
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Affiliation(s)
- Kostas Vemmos
- Acute Stroke Unit, Department of Clinical Therapeutics, Alexandra Hospital, Athens, Greece
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Shoukat S, Gowani SA, Taqui AM, Ul Hassan R, Bhutta ZA, Malik AI, Sherjeel SA, Sheheryar Q, Dhakam SH. Adherence to the European Society of Cardiology (ESC) guidelines for chronic heart failure--a national survey of the cardiologists in Pakistan. BMC Cardiovasc Disord 2011; 11:68. [PMID: 22093082 PMCID: PMC3250933 DOI: 10.1186/1471-2261-11-68] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 11/17/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aims of this study were to evaluate the awareness of and attitudes towards the 2005 European Society of Cardiology (ESC) guidelines for Heart Failure (HF) of the cardiologists in Pakistan and assess barriers to adherence to guidelines. METHODS A cross-sectional survey was conducted in person from March to July 2009 to all cardiologists practicing in 4 major cities in Pakistan (Karachi, Lahore, Quetta and Peshawar). A validated, semi-structured questionnaire assessing ESC 2005 Guidelines for HF was used to obtain information from cardiologists. It included questions about awareness and relevance of HF guidelines (See Additional File 1). Respondents' management choices were compared with those of an expert panel based on the guidelines for three fictitious patient cases. Cardiologists were also asked about major barriers to adherence to guidelines. RESULTS A total of 372 cardiologists were approached; 305 consented to participate (overall response rate, 82.0%). The survey showed a very high awareness of CHF guidelines; 97.4% aware of any guideline. About 13.8% considered ESC guidelines as relevant or very relevant for guiding treatment decisions while 92.8% chose AHA guidelines in relevance. 87.2% of respondents perceived that they adhered to the HF guidelines. For the patient cases, the proportions of respondents who made recommendations that completely matched those of the guidelines were 7% (Scenario 1), 0% (Scenario 2) and 20% (Scenario 3). Respondents considered patient compliance (59%) and cost/health economics (50%) as major barriers to guideline implementation. CONCLUSION We found important self reported departures from recommended HF management guidelines among cardiologists of Pakistan.
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Affiliation(s)
- Sana Shoukat
- Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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A retrospective, observational cohort analysis of a nationwide database to compare heart failure prescriptions and related health care utilization before and after publication of updated treatment guidelines in the United States. Clin Ther 2011; 32:1642-50. [PMID: 20974322 DOI: 10.1016/j.clinthera.2010.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND The current American College of Cardiology/American Heart Association (ACC/AHA) clinical guidelines for heart failure (HF), published September 20, 2005, provide a summary of the best evidence for treatment, but these recommendations are not always reflected in clinical practice. OBJECTIVES The aims of this study were to compare 6-month prescribing habits in the United States before and after the publication of updated clinical guidelines for the evaluation and management of HF and the impact of these prescribing habits on health care resource use. METHODS This retrospective, observational cohort analysis used the Humana nationwide health insurance administrative claims database that includes -3.5 million covered members from all 50 states and Puerto Rico who are enrolled in a health maintenance organization, a preferred provider organization, or a Medicare plan. The data included demographics (age, sex, type of insurance, and geographic location), medical information with up to 9 diagnostic codes per encounter, codes for procedures and medical equipment, laboratory tests, and pharmacy-dispensed medications. HF medication prescriptions and health care utilization were evaluated for 2 cohorts: those identified from claims before guideline publication (January 1, 2005-June 30, 2005) and those identified from claims after publication (October 1, 2006-March 31, 2007). Patients were eligible if they were aged ≥45 years, had 12 months of continuous enrollment (6 months before and 6 months after the index date, defined as the date of diagnosis or hospitalization for HF), and had ≥1 claim for HF. The primary outcome was the proportion of patients who received prescriptions for HF medications individually or in combination. Secondary outcomes were adherence to medication, all-cause and HF-specific hospitalizations, and emergency department and outpatient physician visits. RESULTS The mean (SD) age in the before-publication cohort (n = 29,784) was 75 (11) years; in the after-publication cohort (n = 33,598), it was 74 (11) years (P < 0.001). Half of all patients in each cohort were female (50% [n = 14,796 and n = 16,803, respectively]); 9% (n = 2539) of the before-publication cohort and 7% (n = 2283) of the after-publication cohort were classified as having moderate to severe HF based on the baseline number of hospitalizations (P < 0.001). Fewer patients in the before-publication cohort received angiotensin-converting enzyme inhibitors (43% [12,811/29,784] vs 44% [14,776/33,598]; P = 0.01), β-blockers (37% [10,901/29,784] vs 41% [13,639/33,598]; P < 0.01), angiotensin receptor blockers (10% [3008/29,784] vs 13% [4378/33,598]; P < 0.01), or hydralazine (3% [865/29,784] vs 4% [1378/33,598]; P < 0.01). Among those with moderate to severe HF, there were no significant differences between groups in the use of combination therapy (ie, β-blockers with any combination of isosorbide dinitrate, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, or hydralazine; all combinations, P = NS between cohorts), except for less use of a β-blocker with either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker among the before-publication cohort (23% [595/2539] vs38% [875/2283]; P = 0.005). Therewere significantly fewer all-cause and HF-related outpatient visits, all-cause and HF-related hospitalizations, and all-cause and HF-related emergency department visits in the after-publication cohort (all, P < 0.001); however, the absolute differences in the proportions of patients in each cohort who required such services were relatively small. CONCLUSIONS Based on this analysis of real-world prescribing patterns, only small differences in prescribing practices were found before and after the 2005 publication of the ACC/AHA guidelines for HF treatment. Health care utilization was slightly, but significantly, reduced after publication of the guidelines.
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Braun V, Heintze C, Rufer V, Welke J, Stein T, Mehrhof F, Dini L. Innovative strategy for implementing chronic heart failure guidelines among family physicians in different healthcare settings in Berlin. Eur J Heart Fail 2010; 13:93-9. [PMID: 20947573 DOI: 10.1093/eurjhf/hfq181] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The aim of this study was to improve drug therapy for chronic heart failure (CHF) patients. METHODS AND RESULTS This prospective interventional pilot study was performed with cross-sectional comparative analysis before and after the intervention. Usual pharmacotherapy was observed for 8 months in two different outpatient healthcare settings in Berlin [11 family physicians from individual GP (IGP) practices and 12 working in a medical care centre (MCC)]. Medical care centres provide a novel structure for outpatient care and have recently been introduced in Germany. The subsequent intervention entailed implementation of heart failure guidelines via a computer-based reminder system, followed by renewed cross-sectional observation of prescription behaviour for 1 year. Family physicians recruited patients, assessed CHF severity according to the NYHA class, and referred patients for echocardiography. The study included 190 patients in the baseline phase and 209 in the intervention phase. Longitudinal follow-up was performed in 172 cases. Echocardiography was ordered by 94.6% of MCC-physicians and 79.9% of IGP's. Undermedication was observed in both settings. Guideline-based beta-blocker therapy was prescribed for 46.3% of patients (44.8% of IGPs and 48.5% of MCC-GPs). Prescription improved by 12.3% after the intervention. There were marked deficiencies in the prescription of aldosterone antagonists (35%) for severe heart failure, which improved to 44.2% after the intervention. CONCLUSION The problem of inadequate implementation of evidence-based therapy for CHF was partially overcome by using the reminder system, which provided participating physicians with short guideline recommendations during the intervention phase.
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Affiliation(s)
- Vittoria Braun
- Institute of General Practice & Family Medicine, Charité-Universitätsmedizin, Berlin.
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Frankenstein L, Remppis A, Fluegel A, Doesch A, Katus HA, Senges J, Zugck C. The association between long-term longitudinal trends in guideline adherence and mortality in relation to age and sex. Eur J Heart Fail 2010; 12:574-80. [DOI: 10.1093/eurjhf/hfq047] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Lutz Frankenstein
- Department of Cardiology, Angiology, Pulmonology; University of Heidelberg; Im Neuenheimer Feld 410 Heidelberg D-69120 Germany
| | - Andrew Remppis
- Department of Cardiology, Angiology, Pulmonology; University of Heidelberg; Im Neuenheimer Feld 410 Heidelberg D-69120 Germany
| | | | - Andreas Doesch
- Department of Cardiology, Angiology, Pulmonology; University of Heidelberg; Im Neuenheimer Feld 410 Heidelberg D-69120 Germany
| | - Hugo A. Katus
- Department of Cardiology, Angiology, Pulmonology; University of Heidelberg; Im Neuenheimer Feld 410 Heidelberg D-69120 Germany
| | - Jochen Senges
- Institut für Herzinfarktforschung; Ludwigshafen Germany
| | - Christian Zugck
- Department of Cardiology, Angiology, Pulmonology; University of Heidelberg; Im Neuenheimer Feld 410 Heidelberg D-69120 Germany
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Coexisting chronic obstructive pulmonary disease and heart failure: implications for treatment, course and mortality. Curr Opin Pulm Med 2010; 16:106-11. [PMID: 20042977 DOI: 10.1097/mcp.0b013e328335dc90] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW Chronic obstructive pulmonary disease (COPD) and heart failure are prevalent comorbidities affecting a huge proportion of the world population, responsible for significant morbidity and mortality. Their coexistence is more frequent than previously recognized and poses important diagnostic and therapeutic challenges. Prognosis of patients with concurrent heart failure and COPD has not been comprehensively addressed. With this review, we intend to emphasize the diagnosis and prognosis implications of the two coexisting conditions and to highlight the therapeutic constraints posed by the combination. RECENT FINDINGS Progressively, more attention has been given to the interplay between COPD and heart failure. The combination is frequent, but largely unrecognized due to overlapping clinical manifestations. Patients presenting with both conditions seem to have an ominous course. Despite the overwhelming evidence supporting cardioselective beta-blockade safety and tolerability in COPD patients, beta-blockers are underprescribed to heart failure patients with concomitant COPD. SUMMARY COPD and heart failure coexistence is often overlooked. COPD diagnosis can remain unsuspected in heart failure patients due to similar symptoms. Although beta-blockers are well tolerated in COPD patients, they are overall less prescribed in this challenging population. COPD, at least at severe degrees of airflow obstruction, predicts a worse prognosis in heart failure patients.
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Current World Literature. Curr Opin Pulm Med 2010; 16:162-7. [DOI: 10.1097/mcp.0b013e32833723f8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lainscak M, Coletta AP, Sherwi N, Cleland JGF. Clinical trials update from the Heart Failure Society of America Meeting 2009: FAST, IMPROVE-HF, COACH galectin-3 substudy, HF-ACTION nuclear substudy, DAD-HF, and MARVEL-1. Eur J Heart Fail 2009; 12:193-6. [PMID: 20042425 DOI: 10.1093/eurjhf/hfp185] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
This article presents findings and a commentary on late-breaking trials presented during the meeting of the Heart Failure Society of America in September 2009. Unpublished reports should be considered as preliminary, since analyses may change in the final publication. The FAST trial showed somewhat better performance of intrathoracic impedance for prediction of deterioration in patients with heart failure (HF) when compared with daily weighing. The IMPROVE-HF study reported the benefits of education on the management of patients with systolic HF. Galectin-3 appeared a useful method for improving risk stratification of patients with chronic HF in a substudy of the COACH trial. A nuclear substudy of the HF-ACTION trial failed to demonstrate that resting myocardial perfusion imaging, a measure of myocardial scar and viability, was clinically useful. A small randomized controlled trial (DAD-HF) suggested that the use of low-dose dopamine in patients with acutely decompensated HF was associated with less deterioration in renal function and less hypokalaemia. The MARVEL-1 trial raises further concerns about the safety of myoblast transplantation in ischaemic HF.
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Affiliation(s)
- Mitja Lainscak
- Division of Cardiology, University Clinic of Respiratory and Allergic Diseases Golnik, Golnik 36, SI-4204 Golnik, Slovenia.
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Jondeau G, Neuder Y, Eicher JC, Jourdain P, Fauveau E, Galinier M, Jegou A, Bauer F, Trochu JN, Bouzamondo A, Tanguy ML, Lechat P. B-CONVINCED: Beta-blocker CONtinuation Vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J 2009; 30:2186-92. [DOI: 10.1093/eurheartj/ehp323] [Citation(s) in RCA: 109] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Swedberg K. What should we do about heart failure: challenges for 2009. Eur J Heart Fail 2009; 11:1-2. [DOI: 10.1093/eurjhf/hfn011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Karl Swedberg
- Department of Emergency and Cardiovascular Medicine, Institute of Medicine; Sahlgrenska Academy, University of Gothenburg; SE-41685 Gothenburg Sweden
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