AIMS: To evaluate how recommendations of European guidelines regarding pharmacological and non-pharmacological treatments for heart failure (HF) are adopted in clinical practice. METHODS AND RESULTS: 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, renin-angiotensin 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. CONCLUSION: 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.
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 / Maggioni, Aldo P; Anker, Stefan D.; Dahlström, Ulf; Filippatos, Gerasimos; Ponikowski, Piotr; Zannad, Faiez; Amir, Offer; Chioncel, Ovidiu; Leiro, Marisa Crespo; Drozdz, Jaroslaw; Erglis, Andrejs; Fazlibegovic, Emir; Fonseca, Candida; Fruhwald, Friedrich; Gatzov, Plamen; Goncalvesova, Eva; Hassanein, Mahmoud; Hradec, Jaromir; Kavoliuniene, Ausra; Lainscak, Mitja; Logeart, Damien; Merkely, Bela; Metra, Marco; Persson, Hans; Seferovic, Petar; Temizhan, Ahmet; Tousoulis, Dimitris; Tavazzi, Luigi; Andarala, M.; Fiorucci, E.; Folkesson, E.; Glemot, M.; Gracia, G.; Konte, M.; Laroche, C.; Mcneill, P. a.; Missiamenou, V.; Taylor, C.; Fruhwald, F.; Eberl, Alexander; Heller, S.; Dolze, T.; Platzer, V.; Ablasser, K.; Auer, J.; Poelzl, G.; Moertl, D.; Podczeck Schweighofer, A.; Reiter, S.; Pravdic, D.; Fazlibegovic, E.; Muslibegovic, A.; Vitlianova, K.; Katova, T.; Kotirkov, K.; Petrov, I.; Velikov, T.; Kurteva, T.; Gatzov, P.; Kamenova, D.; Antova, M.; Tisheva, S.; Sirakova, V.; Krejci, J.; Spinar, J.; Mikolaskova, M.; Krupicka, J.; Malek, F.; Hegarova, M.; Pudil, R.; Monhart, Z.; Lazarova, M.; Reda, A.; Khairy, T.; Farag, N.; Saleh, A.; Said, K.; Abdel Hamid, M.; Halawa, S.; Ibrahim, B.; Hanna, R.; Hassanein, M.; Sobhy, M.; El Messiry, F.; El Shazly, A. H.; Elrakshy, Y.; Aboleineen, W.; Gouda, M.; Youssef, A.; Elbahry, A.; Abdel, A.; Ebeid, H.; Nasr, G.; Sobhy, H.; Ashmawy, M.; Lefol, C.; Isnard, R.; Hagege, A.; Thevenin, S.; Jondeau, G.; Logeart, D.; Codjia, R.; Galinier, M.; Bauer, F.; Delahaye, F.; Lamblin, N.; Fertin, M.; De Groote, P.; Coisne, D.; Le Marcis, V.; Lequeux, B.; Ly, J. F.; Lotton, P.; Donal, E.; Le Moal, V.; Basquin, A.; Reynaud, A.; Ridard, C.; Thebault, C.; Behar, N.; Mascle, S.; Schiele, F.; Seronde, M. F.; Morel, M.; Meneveau, N.; Luporsi, P.; Bernard, Y.; Pillot, M.; Briand, F.; Damy, T.; Eicher, J. C.; Avgeropoulou, C.; Panagiotis, T.; Tousoulis, D.; Kotrogiannis, I.; Stefanadis, C.; Chrysohoou, C.; Tsitsinakis, G.; Dimitroula, T.; Karavidas, A.; Matzaraki, V.; Terrovitis, J.; Kapelios, C.; Sfakianaki, T.; Filippatos, G.; Parissis, J. T.; Ntai, K.; Papadopoulou, A.; Tziourganou, H.; Douras, A.; Ntertsas, K.; Karotsaki, T.; Nikoloulis, N.; Tsaknakis, T.; Patrianakos, A.; Nyktari, E.; Vardas, P.; Soos, P.; Nyolczas, N.; Csaba Nagy, A.; Halmosi, R.; Nemeth, F.; Amon, G.; Dinnyes, J.; Vazan Fuhrmann, A.; Shotan, A.; Alony, I.; Elber, J.; Olaru, A.; Valenti, C.; Reggianini, L.; Modena, M. G.; Copelli, S.; Leuzzi, Concetta; Dei Cas, L.; Carubelli, V.; Lombardi, Cecilia; Bulgari, M.; Tanghetti, E.; Quinzani, F.; Metra, M.; Rovetta, R.; Brasolin, B.; Fedele, F.; Sergi, Daniela; Romeo, F.; Scarfò, I.; Vellini, M.; Fabris, E.; Cinquetti, Martino; Stolfo, Davide; Sinagra, Gianfranco; Merlo, Marco; Fucili, A.; Ferrari, R.; Vassanelli, C.; Torelli, F.; Marchese, G.; Zanolla, L.; Cicoira, M.; Anselmi, Manuel; Piccinino, C.; Sartori, C.; Di Ruocco, M. V.; Marino, P. N.; Giordano, A.; Brognoli, S.; Zanelli, E.; Cosmi, F.; Cadeddu, C.; Bandino, S.; Mercuro, G.; Deidda, M.; Salvemini, G.; Correale, M.; Di Biase, M.; Musio, S.; Passero, T.; Italiano, Graziella; Agostoni, P.; Salvioni, E.; Schiavina, G.; Squeri, CARLO ATTILIO; Bosi, S.; Barbieri, A.; Lemme, E.; Penco, M.; Marcon, S.; Romano, S.; Di Mauro, M.; Frisinghelli, A.; Veniani, M.; Pieri, Pietro; Novo, S.; Proclemer, Alessandro; Fresco, C.; Miani, Daniela; Artico, Jessica; Gaita, F.; Bergerone, S.; Pirelli, SALVATORE DONATO; Di Tano, G.; Cattaneo, Silvana; Gualco, A.; Opasich, C.; Priori, S. G.; Iori, Elisa; Leci, E.; Melandri, F.; Voronina, N.; Erglis, A.; Kalnins, A.; Kavoliuniene, A.; Rumbinaite, E.; Kazakauskaite, E.; Petraskiene, I.; Karaliute, R.; Smalinskas, V.; Tamakauskas, V.; Petraskiene, D.; Brazyte Ramanauskiene, R.; Vysniauskas, V.; Nowicka, A.; Grabia, J.; Dankowski, R.; Szyszka, A.; Szymanowska, K.; Straburzynska Migaj, E.; Kaluzna Oleksy, M.; Grajek, S.; Kasztelowicz, P.; Orzel, T.; Bednarczyk, G.; Ruszkowski, P.; Klimkiewicz, J.; Majzner, A.; Matusiak, A.; Bylicka, E.; Kwiatkowska, E.; Kwiatkowska, K.; Ochnio, M.; Krzyzewska, T.; Tarnowska, A.; Komuda, K.; Sobieszczanska Malek, M.; Leszek, P.; Rywik, T.; Wisniewska, J.; Kozar Kaminska, K.; Piotrowska, M.; Zielinski, T.; Mamcarz, A.; Welnicki, M.; Folga, A.; Kaplon Cieslicka, A.; Opolski, G.; Marchel, M.; Balsam, P.; Michalek, A.; Pawlak, A.; Byczkowska, K.; Mozenska, O.; Gil, K.; Gil, R. J.; Skrobowski, A.; Uzieblo Zyczkowska, B.; Piotrowicz, K.; Krzesinski, P.; Stanczyk, A.; Ciurzynski, M.; Bienias, P.; Pruszczyk, P.; Juszczyk, Z.; Switala, P.; Stankala, S.; Polonski, L.; Rozentryt, P.; Gabryel, J.; Lazorko Piega, M.; Kardaszewicz, P.; Poprawa, I.; Komorowska, E.; Lauko Rachocka, A.; Abdulkarim, A. F.; Dudzik Plocica, A.; Zolbach, A.; Sajnaga, D.; Komorowska, K.; Baczynska, K.; Samcik, M.; Wolniewicz, L.; Wozakowska Kaplon, B.; Sosnowska Pasiarska, B.; Bartkowiak, R.; Fiega, A.; Serwicka, A.; Szymczyk, A.; Fitas, G.; Zysko, D.; Poliwczak, A.; Broncel, M.; Bala, A.; Kasprzak, J. D.; Jankowski, L.; Rudzinska, M.; Zycinski, P.; Retwinski, A.; Pietka, I.; Drozdz, J.; Wojtczak Soska, K.; Jankowska, E.; Ponikowski, P.; Cichy, A.; Kostka, A.; Kaminski, L.; Weglarz, J.; Bodys, A.; Flis, P.; Kleinrok, A.; Prokop Lewicka, G.; Mosakowska, K.; Rynkiewicz, A.; Bellwon, J.; Dabrowska Kugacka, A.; Lewicka, E.; Raczak, G.; Skorek, E.; Szabowski, S.; Krysiak, W.; Pietrzak, J.; Gilewski, W.; Sinkiewicz, W.; Furman, A.; Zalewski, J.; Nessler, J.; Bury, K.; Grzegorzko, A.; Zabojszcz, M.; Mirek Bryniarska, E.; Klys, J.; Przybylska, K.; Szulik, M.; Kalarus, Z.; Kuczaj, A.; Nowalany Kozielska, E.; Krzeminski, A.; Ventosa, A.; Tavares Aguiar, C.; Moura, B.; Cardoso, J. S.; De Jesus, I.; Chin, J.; Faria, R.; Pereira, S.; Lima, Giuseppe; Oliveira Guimarães, T.; Francisco, A. R.; Brito, D.; Placido, R.; Martins, S.; Fonseca, C.; Marques, F.; Araujo, I.; Proenca, M.; Cardiga, R.; Andrade, A.; Castro, Alessandra; Pereira, A.; Queirós, C.; Silva, P.; Santos, R.; Lourenço, C.; Moreno, N.; Almeida, F.; Quelhas, I.; Baptista, A.; Ferreira, A.; Magalhaes, P.; Ferreira, Clara; Moreira, I.; Durao, D.; Severino, D.; Ferreira Da Silva, G.; Marta, L.; Peres, Martina; Stanescu, C.; Dan, A.; Dan, G. A.; Daha, I.; Popescu, R.; Vinereanu, D.; Sinescu, C. J.; Macarie, C.; Radoi, M.; Nechita, E.; Christodorescu, R.; Datcu, M.; Craiu, E.; Otasevic, P.; Ristic, A. D.; Simeunovic, D.; Seferovic, P.; Pencic, B.; Andric, A.; Stojcevski, B.; Lebedinski, E.; Suzic Lazic, J.; Celic, V.; Krotin, M.; Radovanovic, Slavena; Iric Cupic, V.; Milanov, S.; Davidovic, G.; Jovic, Masa; Radin, A.; Mihajlovic, B.; Stojiljkovic, J.; Cankovic, M.; Cemerlic Adic, N.; Dodic, Sara; Kecojevic, S.; Stojsic, S.; Petrovic, D.; Deljanin Ilic, M.; Ilić, Saša; Stoickov, V.; Antic, S.; Stanojevic, D.; Pavlovic, M.; Atanaskovic, V.; Mitic, Vanja; Kovar, F.; Goncalvesova, E.; Murin, J.; Pernicky, M.; Klabnik, A.; Kmec, J.; Rajtman, D.; Kovac, D.; Horvat, Sara; Krunic, B.; Bombek, M.; Krajnc, I.; Losic, R.; Glavic, T.; Komel, Janja; Cernic Suligoj, N.; Ravnikar, T.; Letonja, M.; Cencic, Vanja; Savnik Iskra, M.; Strasek, M.; Leskovar, B.; Drnovsek, B.; Klen, J.; Marolt, A.; Kladnik, M.; Slemenik Pusnik, C.; Pusnik Vrckovnik, M.; Jug, Barbara; Fras, Z.; Bartolic, Andrej; Melihen Bartolic, C.; Valentincic, M.; Winkler, R.; Blanco Canosa, P.; Grille Cancela, Z.; Crespo Leiro, M.; Paniagua Martin, M. J.; Marzoa Rivas, R.; Barge Caballero, E.; Torres Calvo, F.; Bravo Marques, R.; Epelde Gonzalo, F.; Recio Platero, A.; De La Fuente Galan, L.; Lopez Diaz, J.; Goncalvez Ramirez, L. Renier; Cubero Gallego, H.; Sliwiski Herrera, J. F.; Bierge Valero, D.; Salmeron, F. M.; Gallego Page, J. C.; Jose Fernandez, M.; Sahuquillo, A.; Garcia De La Villa, B.; Castro Conde, A.; Iniesta Manjavacas, A. M.; Salvador Montanes, O.; Gonzalez Gallarza, R. Dalmau; Ofelia Rosillo, S.; Araujo, A.; Briceno, A.; Alonso Pulpon, L.; Cobo, M.; Soria, T.; Gomez Bueno, M.; Garcia Pavia, P.; Gonzalez Segovia, A.; Sayago, I.; Segovia Cubero, J.; Delgado Jiménez, J. F.; Angel Gomez Sanchez, M.; Escribano Subias, P.; Barrios Garrido Lestache, E.; Ruiz Cano, M. J.; Vicente Hernandez, M.; Puga Martinez, M.; Lopez Moreno, E.; Serrano Martinez, J. L.; Fernandez Alvarez, M.; Rivera Lopez, R.; Lopez Fernandez, S.; Alcade Martinez, V.; Sanmartin, M.; Pellicer Cabo, A.; Garcia Escriva, D.; Ridocci Soriano, F.; Perez Silvestre, J.; Facila Rubio, L.; Garcia Gonzalez, P.; Sanchez Lazaro, I. J.; Almenar Bonet, L.; Garcia Pinilla, J. M.; Andres, Ulrike Julia; Bayes Genis, A.; Roig, E.; Mirabet, S.; Mendez, A.; Garcia Cosio, L.; Garay, A.; Muntane, G.; Gonzalez Costello, J.; Leon, V.; Diaz Molina, B.; Famara Hernandez, I.; Lara Padron, A.; Laynez Cerdena, I.; Mateo, I.; Quiles, J.; Bertomeu, V.; Elamrani, A.; Angel Rodrigez Ortega, J.; Martinez Abellan, R.; Valero, R.; Fernandez Vivancos, C.; Sanz Julve, M.; Perez Martinez, M. T.; Pascual Figal, D. A.; Martinez Martinez Espejo, M. D.; Rosario Gracia Rodenas, M.; Pastor Perez, F.; Melin, M.; Hägglund, E.; Stenberg, A.; Lindahl, I. M.; Asserlund, B.; Olsson, L.; Dahlström, U.; Afzelius, M.; Karlström, P.; Tengvall, L.; Wiklund, P. A.; Olsson, B.; Temizhan, A.; Kalayci, S.; Bozkurt, M.; Taraktas, M.; Cavusoglu, Y.; Gunes, H.; Birhan Yilmaz, M.; Demir, B.; Gencer, E.. - In: EUROPEAN JOURNAL OF HEART FAILURE. - ISSN 1388-9842. - 15:10(2013), pp. 1173-1184. [10.1093/eurjhf/hft134]
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
Fabris, E.;STOLFO, DAVIDEMembro del Collaboration Group
;SINAGRA, GIANFRANCOMembro del Collaboration Group
;MERLO, MARCOMembro del Collaboration Group
;ARTICO, JESSICAMembro del Collaboration Group
;FERREIRA, CLARAMembro del Collaboration Group
;
2013-01-01
Abstract
AIMS: To evaluate how recommendations of European guidelines regarding pharmacological and non-pharmacological treatments for heart failure (HF) are adopted in clinical practice. METHODS AND RESULTS: 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, renin-angiotensin 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. CONCLUSION: 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.Pubblicazioni consigliate
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