Institute of Cardiometabolism and Nutrition (ICAN), Pierre & Marie Curie Paris VI University, La Pitié-Salpétrière Hospital, AP-HP, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Centre Göttingen (UMG), Göttingen, Germany.
Eur J Heart Fail. 2016 May;18(5):514-22. doi: 10.1002/ejhf.510. Epub 2016 Apr 20.
To assess physicians' adherence to guideline-recommended medications for the treatment of chronic heart failure (CHF) with reduced ejection fraction.
QUALIFY is an international prospective observational longitudinal survey of 7092 CHF outpatients recruited 1-15 months after hospitalization for heart failure from September 2013 to December 2014 in 547 centres in 36 countries. We constructed a five-class guideline adherence score for angiotensin converting enzyme inhibitors (ACEIs), beta-blockers, angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists, and ivabradine. The adherence score was good in 67%, moderate in 25%, and poor in 8% of patients. Adherence was lower in women than men but there were differences in age (65.7 ± 12.5 years women vs. 62.2 ± 12.4 years men, P < 0.001) and the proportion of women at ≥50% target dose of beta-blockers was lower in those >67 years (median) (11% vs. 16.2%, P = 0.005). Geographic variations were observed with lower adherence scores in Central/Eastern European countries. The proportion of patients at target dose and ≥50% of target dose was low (27.9% and 63.3% for ACEIs, 14.8% and 51.8% for beta-blockers, 6.9% and 39.5% for ARBs, and 6.9% and 39.5% for ivabradine, respectively). It was also lower in patients most recently hospitalized (<6 vs. ≥6 months) except for beta-blockers.
This international survey shows that adherence to guideline-recommended medications is relatively satisfactory but the dosage of recommended CHF medications is usually suboptimal. Action plans aimed at improving adherence to guidelines are required.
评估医生对射血分数降低的慢性心力衰竭（CHF）治疗的指南推荐药物的依从性。
QUALIFY 是一项国际性的前瞻性观察性纵向调查，共纳入了 36 个国家的 547 个中心的 7092 例 CHF 门诊患者，这些患者在心力衰竭住院后 1-15 个月内于 2013 年 9 月至 2014 年 12 月间入组。我们为血管紧张素转换酶抑制剂（ACEIs）、β受体阻滞剂、血管紧张素受体阻滞剂（ARBs）、盐皮质激素受体拮抗剂和伊伐布雷定构建了一个 5 类指南依从性评分。67%的患者依从性良好，25%的患者依从性中等，8%的患者依从性差。女性患者的依从性低于男性，但年龄存在差异（女性为 65.7±12.5 岁，男性为 62.2±12.4 岁，P<0.001），≥50%目标剂量β受体阻滞剂的女性比例在＞67 岁（中位数）患者中较低（11%比 16.2%，P=0.005）。观察到地理差异，中东欧国家的依从性评分较低。目标剂量和≥50%目标剂量的患者比例较低（ACEIs 分别为 27.9%和 63.3%，β受体阻滞剂为 14.8%和 51.8%，ARBs 为 6.9%和 39.5%，伊伐布雷定为 6.9%和 39.5%）。最近（<6 个月 vs. ≥6 个月）住院的患者比例也较低，β受体阻滞剂除外。
这项国际调查表明，对指南推荐药物的依从性相对令人满意，但推荐的 CHF 药物剂量通常并不理想。需要制定行动计划以提高对指南的依从性。
