Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey
Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey
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DOI：
10.1093/eurheartj/ehi251
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发表时间：
2005-08-01
影响因子：
39.3
通讯作者：
Le Pen, C
中科院分区：
文献类型：
--
作者：
Komajda, M;Lapuerta, P;Le Pen, C
欧洲慢性心力衰竭（CHF）治疗指南的实施对结果的影响尚未得到评估。我们调查了依从心脏病专家护理对CHF和心血管（CV）住院率以及心血管住院时间的影响。方法和结果我们构建了血管紧张素转换酶（ACE）抑制剂、受体阻滞剂、螺旋内酯、利尿剂、心脏糖苷和gal的分级依从性指标（GAl3对前三类心力衰竭药物的依从性，GAl5对五类心力衰竭药物的依从性）。在这项研究中，1410名可评估的患者（平均年龄69岁，69%的男性，纽约心脏协会（NYHA） II: 64%, III: 34%, IV: 2%）被纳入研究，并由来自六个欧洲国家（法国、德国、意大利、荷兰、西班牙和英国）的150名随机选择的心脏病专家/心脏病科随访6个月。总体而言，治疗指南的依从性分别为60% （GAl3）和63% (GAl5), ACE-]（88%）或利尿剂（82%）优于心脏糖苷类（52%）、受体阻滞剂（58%）和内酯类（36%）。在平均依从性评分值下降的人群中，CHF和CV住院率分别为6.7、9.7和14.7%和11%。2、15.9、20.6% （P < 0.002、P < 0.001）。在一个多变量模型中，全球依从性指标GAl3与NYHA等级、CHF住院史、缺血性病因、糖尿病和高血压一起是CV住院时间的独立预测因子。结论：我们证明，在实际实践中，医生对治疗指南的遵守是减少CV住院的一个强有力的预测因素。在这种情况下，有必要制定进一步的质量改进方案。
Aims The impact on outcome of the implementation of European guidelines for the treatment of chronic heart failure (CHF) has not been evaluated. We investigated the consequences of adherence to care by cardiologists on the rate of CHF and cardiovascular (CV) hospitalizations and time to CV hospitalization.Methods and results We constructed class adherence indicators for angiotensin-converting enzyme (ACE) -inhibitors, beta-blockers, spironotactone, diuretics, and cardiac glycosides and GAls (GAl3 adherence to first three classes of heart failure medication, GAl5 adherence to five classes). In the study, 1410 evaluable patients (mean age 69, 69% mates, New York Heart Association (NYHA) II: 64%, III: 34%, IV: 2%) were enrolled and followed up for 6 months by 150 randomly selected cardiologists/cardiology departments from six European countries (France, Germany, Italy, The Netherlands, Spain, and UK). Overall, adherence to treatment guidelines was 60 (GAl3) and 63% (GAl5) and was better for ACE-] (88%) or diuretics (82%) than for cardiac gtycosides (52%), beta-blockers (58%), and spironolactone (36%). In the three tertites of the population defined by a decreasing mean adherence score value, CHF and CV hospitalization rates were, respectively, 6.7, 9.7, and 14.7% and 11. 2, 15.9, and 20.6% (P < 0.002 and P < 0.001, respectively). Global adherence indicator GAl3 was an independent predictor of time to CV hospitalization in a multi-variable model together with NYHA Class, history of CHF hospitalization, ischaemic aetiology, diabetes mellitus, and hypertension.Conclusion We demonstrate that adherence of physicians to treatment guidelines is a strong predictor of fewer CV hospitalizations in actual practice. There is a need to develop further quality improvement programmes in this condition.