Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
SHR Neuro Krebs Kardio Lipid Stoffw Microb
Poelzl, G; Altenberger, J; Pacher, R; Ebner, CH; 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; Austrian Working Group on Heart Failure.
Dose matters! Optimisation of guideline adherence is associated with lower mortality in stable patients with chronic heart failure.
Int J Cardiol. 2014; 175(1):83-89
Doi: 10.1016/j.ijcard.2014.04.255
Web of Science
PubMed
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- Co-Autor*innen der Med Uni Graz
- Ablasser Klemens
- Fruhwald Friedrich
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- Abstract:
- 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. 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. 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. 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. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
- Find related publications in this database (using NLM MeSH Indexing)
- Aged -
- Aged - epidemiology
- Cardiovascular Agents - administration & dosage
- Chronic Disease -
- Female -
- Follow-Up Studies -
- Guideline Adherence - trends
- Heart Failure - diagnosis
- Heart Failure - drug therapy
- Heart Failure - mortality
- Humans -
- Male -
- Medication Adherence -
- Middle Aged -
- Mortality - trends
- Registries -
- Find related publications in this database (Keywords)
- Chronic heart failure
- Guideline adherence indicator
- Treatment adjustment
- Prognosis