Department of Cardiology, Groupe Hospitalier, Paris Saint Joseph, Paris, France.
Institute for Medical Biometry, Epidemiology and Medical Informatics, Saarland University, Homburg, Germany.
Eur J Heart Fail. 2019 Jul;21(7):921-929. doi: 10.1002/ejhf.1459. Epub 2019 Apr 1.
Physicians' adherence to guideline-recommended therapy is associated with short-term clinical outcomes in heart failure (HF) with reduced ejection fraction (HFrEF). However, its impact on longer-term outcomes is poorly documented. Here, we present results from the 18-month follow-up of the QUALIFY registry.
Data at 18 months were available for 6118 ambulatory HFrEF patients from this international prospective observational survey. Adherence was measured as a continuous variable, ranging from 0 to 1, and was assessed for five classes of recommended HF medications and dosages. Most deaths were cardiovascular (CV) (228/394) and HF-related (191/394) and the same was true for unplanned hospitalizations (1175 CV and 861 HF-related hospitalizations, out of a total of 1541). According to univariable analysis, CV and HF deaths were significantly associated with physician adherence to guidelines. In multivariable analysis, HF death was associated with adherence level [subdistribution hazard ratio (SHR) 0.93, 95% confidence interval (CI) 0.87-0.99 per 0.1 unit adherence level increase; P = 0.034] as was composite of HF hospitalization or CV death (SHR 0.97, 95% CI 0.94-0.99 per 0.1 unit adherence level increase; P = 0.043), whereas unplanned all-cause, CV or HF hospitalizations were not (all-cause: SHR 0.99, 95% CI 0.9-1.02; CV: SHR 0.98, 95% CI 0.96-1.01; and HF: SHR 0.99, 95% CI 0.96-1.02 per 0.1 unit change in adherence score; P = 0.52, P = 0.2, and P = 0.4, respectively).
These results suggest that physicians' adherence to guideline-recommended HF therapies is associated with improved outcomes in HFrEF. Practical strategies should be established to improve physicians' adherence to guidelines.
在射血分数降低的心力衰竭（HFrEF）中，医生遵循指南推荐的治疗方案与短期临床结局相关。然而，其对长期结局的影响记录甚少。在此，我们报告了 QUALIFY 注册研究的 18 个月随访结果。
这项国际前瞻性观察性研究共纳入 6118 例门诊 HFrEF 患者，可获得其 18 个月的数据。采用连续变量衡量依从性，范围为 0 至 1，并评估了五类推荐的 HF 药物及其剂量。大多数死亡为心血管（CV）（228/394）和 HF 相关（191/394），同样，计划外住院也如此（1541 例中 CV 住院 1175 例，HF 住院 861 例）。根据单变量分析，CV 和 HF 死亡与医生遵循指南显著相关。多变量分析显示，HF 死亡与依从水平相关[亚分布危险比（SHR）为 0.93，95%置信区间（CI）为 0.87-0.99，每增加 0.1 个依从水平单位；P=0.034]，HF 住院或 CV 死亡复合终点也与依从水平相关（SHR 为 0.97，95%CI 为 0.94-0.99，每增加 0.1 个依从水平单位；P=0.043），而计划外全因、CV 或 HF 住院则不相关（全因：SHR 为 0.99，95%CI 为 0.9-1.02；CV：SHR 为 0.98，95%CI 为 0.96-1.01；HF：SHR 为 0.99，95%CI 为 0.96-1.02，每增加 0.1 个依从评分单位；P=0.52、P=0.2 和 P=0.4）。
这些结果表明，医生遵循指南推荐的 HF 治疗方案与 HFrEF 的改善结局相关。应制定实用策略来提高医生的依从性。
