Pol Arch Intern Med. 2017 Oct 31;127(10):657-665. doi: 10.20452/pamw.4083. Epub 2017 Aug 8.
INTRODUCTION Adherence to guidelines is associated with improved patient prognosis. OBJECTIVES The aim of this study was to evaluate adherence to guidelines on the management of heart failure (HF) in ambulatory care in Poland. PATIENTS AND METHODS The study included 209 outpatients with HF who participated in the prospective, observational QUALIFY survey. The inclusion criteria were as follows: age of 18 years or older, systolic HF with left ventricular ejection fraction of 40% or lower, and hospitalization for HF exacerbation within the previous 1 to 15 months. We assessed prescription of medications for HF and dose selection (classified as a target dose or as 50% or more of the target dose). The adherence score was calculated on the basis of the use of angiotensin‑converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β‑blockers, mineralocorticoid receptor antagonists (MRAs), and ivabradine. The use of all indicated medications was scored as good adherence; of more than half of the medications, as moderate adherence; and of half of the medications or fewer, as poor adherence. RESULTS The mean (SD) age of the patients was 67.4 (10.9) years; men constituted 77.0% of the population. Almost 92.0% of the patients were prescribed ACEIs or ARBs, of whom only 27.4% and 4.0%, respectively, reached the target doses. Nearly 97.0% of the patients received β‑blockers, with only 17.7% reaching the target dose. MRAs were prescribed in 73.2% of the patients, of whom 66.0% reached the target dose. Ivabradine was prescribed in 13.9% of the patients, but the target dose was attained only in 13.8%. The adherence was good in 72.2%, moderate in 23.9%, and poor in 3.8% of the study population. CONCLUSIONS Most patients with HF in Poland receive adequate treatment, but the proportion of patients reaching the target doses is suboptimal.
简介 遵循指南与改善患者预后相关。 目的 本研究旨在评估波兰门诊心力衰竭（HF）管理指南的遵循情况。 患者和方法 该研究纳入了 209 名参加前瞻性观察性 QUALIFY 研究的 HF 门诊患者。纳入标准如下：年龄≥18 岁，射血分数为 40%或更低的收缩性 HF，以及在过去 1 至 15 个月内因 HF 加重而住院。我们评估了 HF 药物的处方和剂量选择（分为目标剂量或为目标剂量的 50%或更多）。根据血管紧张素转换酶抑制剂（ACEI）、血管紧张素受体阻滞剂（ARB）、β受体阻滞剂、盐皮质激素受体拮抗剂（MRA）和伊伐布雷定的使用情况计算了依从性评分。所有推荐药物的使用均被评为良好依从性；超过一半药物的使用为中度依从性；一半或更少药物的使用为差的依从性。 结果 患者的平均（SD）年龄为 67.4（10.9）岁；男性占人口的 77.0%。近 92.0%的患者处方了 ACEI 或 ARB，其中分别只有 27.4%和 4.0%达到了目标剂量。近 97.0%的患者接受了β受体阻滞剂治疗，但只有 17.7%达到了目标剂量。73.2%的患者处方了 MRA，其中 66.0%达到了目标剂量。伊伐布雷定在 13.9%的患者中使用，但只有 13.8%的患者达到了目标剂量。研究人群中，依从性良好的占 72.2%，中等的占 23.9%，差的占 3.8%。 结论 波兰大多数 HF 患者接受了充分的治疗，但达到目标剂量的患者比例不理想。
