ArticleClinical research in cardiology : official journal of the German Cardiac Society2008
Guideline adherence for pharmacotherapy of chronic systolic heart failure in general practice: a closer look on evidence-based therapy.
Article in Clinical research in cardiology : official journal of the German Cardiac Society, 2008. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed, 44 citations in OpenAlex.
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- Bisoprolol vs. carvedilol in elderly patients with heart failure: rationale and design of the CIBIS-ELD trial.Clinical research in cardiology : official journal of the German Cardiac Society · 2008Trial
- Physician adherence and patient-reported outcomes in heart failure with reduced ejection fraction in the era of angiotensin receptor-neprilysin inhibitor therapy.Scientific reports · 2022Article
- Guideline-led prescribing to ambulatory heart failure patients in a cardiology outpatient service.International journal of clinical pharmacy · 2021Article
- Temporal trends in heart failure medication prescription in a population-based cohort study.BMJ open · 2021Article
- Medical therapy doses at hospital discharge in patients with existing and de novo heart failure.ESC heart failure · 2019Article
- Beta blockers and chronic heart failure patients: prognostic impact of a dose targeted beta blocker therapy vs. heart rate targeted strategy.Clinical research in cardiology : official journal of the German Cardiac Society · 2018Article
- Design of a bilevel clinical trial targeting adherence in heart failure patients and their providers: The Congestive Heart Failure Adherence Redesign Trial (CHART).American heart journal · 2018Article
- Ivabradine in Patients with Stable Coronary Artery Disease: A Rationale for Use in Addition to and Beyond Percutaneous Coronary Intervention.Clinical drug investigation · 2017Review
- Observational
- Gaps in Medical and Device Therapy for Patients with Left Ventricular Systolic Dysfunction: The EchoGap Study.The open cardiovascular medicine journal · 2014Article
- What will be the role of I-123 MIBG in improving the outcome of medically treated heart failure patients?Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology · 2012Review
- Physician and patient predictors of evidence-based prescribing in heart failure: a multilevel study.PloS one · 2012Article
- Adherence to the European Society of Cardiology (ESC) guidelines for chronic heart failure--a national survey of the cardiologists in Pakistan.BMC cardiovascular disorders · 2011Article
- The initial slope of the VCO2/VO2-curve (s1) in cardiopulmonary exercise testing is a strong and independent predictor of outcome in patients with previous myocardial infarction.Clinical research in cardiology : official journal of the German Cardiac Society · 2008Article
- Primary ICD-therapy in patients with advanced heart failure: selection strategies and future trials.Clinical research in cardiology : official journal of the German Cardiac Society · 2008Article
- Heart failure, aging and beta-blockers: the need for more data on tolerability and efficacy.Clinical research in cardiology : official journal of the German Cardiac Society · 2008Article
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThere is robust evidence for effective pharmacotherapy of chronic (systolic) heart failure (CHF) which has led to the creation of guidelines, but many surveys evaluating CHF treatment show an under-utilisation of relevant drugs, while setting and patient population appear to be crucial for adequate appraisal of treatment patterns.
aimsTo evaluate the guideline adherence (GA) of general practitioners (GPs) in a well-defined patient population with CHF in primary care (PC).
methodsA cross-sectional analysis was performed with the data of 167 patients enrolled in 37 GP practices (Germany) with documented left ventricular systolic dysfunction (LVEF: 33.3 +/- 6.9%). GA was assessed as usual (prescribing "yes" or "no"), through evaluation of target dosing, while adjusting for potential clinical contraindications, and through a modified Guideline Adherence Indicator-3 (mGAI-3), which assesses three relevant groups of substances according to New York Heart Association (NYHA) functional class: ACE-Inhibitors (ACE-I) or angiotensin receptor blockers (ARB), beta-blockers (BB) and aldosterone-antagonists (AA).
resultsPrescription rates for ACE-I/ARB, BB or both were 80%, 75% and 62%, respectively. The proportion of target doses reached for ACE-I was 16%, for BB only 8%. When adjusted for potential (mainly relative) contraindications (COPD, heart rate <60/min, hypotension, hyperkalaemia and renal dysfunction), the percentage of target doses reached increased to 49% for ACE-I/ARBs and 46% for BB. Application of the mGAI-3 showed moderate to perfect GA for usual assessment, proportion of target dose reached and adjusted in 83%, 16% and 55% of the patients, respectively.
conclusionIn the context of this patient and doctor setting, life-saving treatment was provided above average when assessed by usual criteria. The application of additional criteria showed further room for improvement. Future interventions aiming at optimisation should be tailored to the needs of doctors and patients likewise.
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