Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC Heart Failure Long-Term Registry
Por:
Maggioni, AP, Anker, SD, Dahlstrom, U, Filippatos, G, Ponikowski, P, Zannad, F, Amir, O, Chioncel, O, Leiro, MC, Drozdz, J, Erglis, A, Fazlibegovic, E, Fonseca, C, Fruhwald, F, Gatzov, P, Goncalvesova, E, Hassanein, M, Hradec, J, Kavoliuniene, A, Lainscak, M, Logeart, D, Merkely, B, Metra, M, Persson, H, Seferovic, P, Temizhan, A, Tousoulis, D, Tavazzi, L, Roig E., Mirabet S., ESC HFA
Publicada:
1 oct 2013
Resumen:
To evaluate how recommendations of European guidelines regarding pharmacological and non-pharmacological treatments for heart failure (HF) are adopted in clinical practice.
The ESC-HF Long-Term Registry is a prospective, observational study conducted in 211 Cardiology Centres of 21 European and Mediterranean countries, members of the European Society of Cardiology (ESC). From May 2011 to April 2013, a total of 12 440 patients were enrolled, 40.5 with acute HF and 59.5 with chronic HF. Intravenous treatments for acute HF were heterogeneously administered, irrespective of guideline recommendations. In chronic HF, with reduced EF, reninangiotensin system (RAS) blockers, beta-blockers, and mineralocorticoid antagonists (MRAs) were used in 92.2, 92.7, and 67.0 of patients, respectively. When reasons for non-adherence were considered, the real rate of undertreatment accounted for 3.2, 2.3, and 5.4 of the cases, respectively. About 30 of patients received the target dosage of these drugs, but a documented reason for not achieving the target dosage was reported in almost two-thirds of them. The more relevant reasons for non-implantation of a device, when clinically indicated, were related to doctor uncertainties on the indication, patient refusal, or logistical/cost issues.
This pan-European registry shows that, while in patients with acute HF, a large heterogeneity of treatments exists, drug treatment of chronic HF can be considered largely adherent to recommendations of current guidelines, when the reasons for non-adherence are taken into account. Observations regarding the real possibility to adhere fully to current guidelines in daily clinical practice should be seriously considered when clinical practice guidelines have to be written.
Filiaciones:
Maggioni, AP:
ANMCO Res Ctr, Florence, Italy
Anker, SD:
Campus Virchow Klinikum, Charite Med Sch, Dept Cardiol, Berlin, Germany
Dahlstrom, U:
Linkoping Univ Hosp, Dept Cardiol, S-58185 Linkoping, Sweden
Filippatos, G:
Univ Athens, Hosp Attikon, Athens, Greece
Ponikowski, P:
Mil Hosp, Dept Cardiol, Wroclaw, Poland
Zannad, F:
Nancy Univ, INSERM, CIC9501, Nancy, France
Nancy Univ, CHU, U961, Nancy, France
Nancy Univ, Dept Cardiol, Nancy, France
Chioncel, O:
Inst deBoliCardiovasc CC Iliescu, Bucharest, Romania
Leiro, MC:
Hosp Univ A Coruna, Unidad Insuficiencia Cardiaca Avanzada & Trasplan, La Coruna, Spain
Drozdz, J:
Med Univ Lodz, Dept Cardiol, Lodz, Poland
Erglis, A:
Pauls Stradins Clin Univ Hosp, Riga, Latvia
Fazlibegovic, E:
Clin Hosp Mostar, Mostar, Bosnia & Herceg
Fonseca, C:
Univ Nova Lisboa, S Francisco Xavier Hosp, Lisbon, Portugal
Fruhwald, F:
Med Univ, Dept Cardiol, Graz, Austria
Gatzov, P:
Univ Hosp Lozenets, Sofia, Bulgaria
Goncalvesova, E:
Natl Inst Cardiovasc Dis NUSCH, Bratislava, Slovakia
Hassanein, M:
Univ Alexandria, Alexandria, Egypt
Hradec, J:
Charles Univ Prague, Fac Gen Hosp, Dept Med 3, Prague, Czech Republic
Kavoliuniene, A:
Lithuanian Univ Hlth Sci, Dept Cardiol, Kaunas, Lithuania
Lainscak, M:
Univ Clin Resp & Allerg Dis Golnik, Div Cardiol, Golnik, Slovenia
Logeart, D:
Lariboisiere Hosp, INSERM, Dept Cardiol, UMR 942, Paris, France
Merkely, B:
Semmelweis Univ, Ctr Heart, H-1085 Budapest, Hungary
Metra, M:
Univ Brescia, Spedali Civili, Dipartimento Med Sperimentale & Applicata, Cattedra Cardiol, Brescia, Italy
Persson, H:
Danderyd Hosp, Dept Cardiol, Stockholm, Sweden
Seferovic, P:
Clin Ctr Serbia, Dept Cardiol, Belgrade, Serbia
Temizhan, A:
Turkey Yuksek Ihtisas Hosp, Cardiol Clin, Ankara, Turkey
Tousoulis, D:
Univ Athens, Sch Med, Cardiol Dept 1, GR-11527 Athens, Greece
Tavazzi, L:
Ettore Sansavini Hlth Sci Fdn, Maria Cecilia Hosp, GVM Care & Res, Cotignola, Italy
Roig E.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
Mirabet S.:
Institut d’Investigació Biomèdica Sant Pau (IIB SANT PAU), Sant Quintí 77-79, 08041 Barcelona, Spain
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