Division of Cardiology, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea.
Division of Cardiology, Yonsei University Severance Hospital, Seoul, Korea.
PLoS One. 2014 Jan 27;9(1):e86596. doi: 10.1371/journal.pone.0086596. eCollection 2014.
Clinical practice guidelines have been slowly and inconsistently applied in clinical practice, and certain evidence-based, guideline-driven therapies for heart failure (HF) have been significantly underused. The purpose of this study was to survey guideline compliance and its effect on clinical outcomes in the treatment of systolic HF in Korea.
The SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real World (SUGAR) trial was a multi-center, retrospective, observational study on subjects with systolic HF (ejection fraction <45%) admitted to 23 university hospitals. The guideline adherence indicator (GAI) was defined as a performance measure on the basis of 3 pharmacological classes: angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), beta-blocker (BB), and aldosterone antagonist (AA). Based on the overall adherence percentage, subjects were divided into 2 groups: those with good guideline adherence (GAI ≥50%) and poor guideline adherence (GAI <50%). We included 1319 regional participants as representatives of the standard population from the Korean national census in 2008. Adherence to drugs at discharge was as follows: ACEI or ARB, 89.7%; BB, 69.2%; and AA, 65.9%. Overall, 82.7% of the patients had good guideline adherence. Overall mortality and re-hospitalization rates at 1 year were 6.2% and 37.4%, respectively. Survival analysis by log-rank test showed a significant difference in event-free survival rate of mortality (94.7% vs. 89.8%, p = 0.003) and re-hospitalization (62.3% vs. 56.4%, p = 0.041) between the good and poor guideline-adherence groups.
Among patients with systolic HF in Korea, adherence to pharmacologic treatment guidelines as determined by performance measures, including prescription of ACEI/ARB and BB at discharge, was associated with improved clinical outcomes.
临床实践指南在临床实践中的应用一直缓慢且不一致，某些基于证据的、指南驱动的心力衰竭（HF）治疗方法的使用率明显较低。本研究旨在调查韩国治疗收缩性 HF 时的指南依从性及其对临床结局的影响。
SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real World（SUGAR）试验是一项多中心、回顾性、观察性研究，纳入了 23 家大学医院因收缩性 HF（射血分数<45%）入院的患者。指南依从性指标（GAI）是根据 3 种药物类别（血管紧张素转换酶抑制剂[ACEI]或血管紧张素受体 II 阻滞剂[ARB]、β受体阻滞剂[BB]和醛固酮拮抗剂[AA]）制定的绩效指标。根据总体依从百分比，患者分为 2 组：药物依从性好（GAI≥50%）和药物依从性差（GAI<50%）。我们纳入了 2008 年韩国全国人口普查的 1319 名地区参与者作为标准人群的代表。出院时药物的依从性如下：ACEI 或 ARB 为 89.7%；BB 为 69.2%；AA 为 65.9%。总体而言，82.7%的患者具有良好的指南依从性。1 年时的总死亡率和再住院率分别为 6.2%和 37.4%。对数秩检验的生存分析显示，死亡率（94.7% vs. 89.8%，p=0.003）和再住院率（62.3% vs. 56.4%，p=0.041）的无事件生存率在依从性好和差的两组之间有显著差异。
在韩国的收缩性 HF 患者中，通过绩效指标确定的药物治疗指南的依从性，包括出院时开具 ACEI/ARB 和 BB，与改善临床结局相关。
