کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
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5971232 | 1576183 | 2014 | 7 صفحه PDF | دانلود رایگان |
AimsGuidelines 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.MethodsData 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 ÎGAI-positive if GAI improved to or remained at high levels (â¥Â 80%). ÎGAI50 + positivity was ascribed to patients achieving a dose of â¥Â 50% of suggested target dose.ResultsImprovements 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.ConclusionsImprovement 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.
Journal: International Journal of Cardiology - Volume 175, Issue 1, 15 July 2014, Pages 83-89