Are Hospitalized or Ambulatory Patients with Heart Failure Treated in Accordance with European Society of Cardiology Guidelines? Evidence from 12 440 Patients of the ESC Heart Failure Long-Term Registry

作者：Aldo P. Maggioni, Stefan D. Anker, Ulf Dahlström, Gerasimos Filippatos, Piotr Ponikowski, Faı̈ez Zannad, Offer Amir, Ovidiu Chioncel, María G. Crespo‐Leiro, Jarosław Dróżdż, Andrejs Ērglis, Emir Fazlibegović, Cândida Fonseca, Friedrich Fruhwald, Plamen Gatzov, Eva Gonçalvesová, Mahmoud Hassanein, J Hradec, Aušra Kavoliūnienė, Mitja Lainščak, Damien Logeart, Béla Merkely, Marco Metra, Hans Persson, Petar Seferović, Ahmet Temizhan, Dimitris Tousoulis, Luigi Tavazzi · 发表于：European Journal of Heart Failure · 年份：2013 · DOI：10.1093/eurjhf/hft134 · 被引用次数：670 · 研究领域：Heart Failure Treatment and Management、Medication Adherence and Compliance、Diabetes Treatment and Management

AIMS: To evaluate how recommendations of European guidelines regarding pharmacological and non-pharmacological treatments for heart failure (HF) are adopted in clinical practice. METHODS AND RESULTS: The ESC-HF Long-Term Registry is a prospective, observational study conducted in 211 Cardiology Centres of 21 European and Mediterranean countries, members of the European Society of Cardiology (ESC). From May 2011 to April 2013, a total of 12,440 patients were enrolled, 40.5% with acute HF and 59.5% with chronic HF. Intravenous treatments for acute HF were heterogeneously administered, irrespective of guideline recommendations. In chronic HF, with reduced EF, renin-angiotensin system (RAS) blockers, beta-blockers, and mineralocorticoid antagonists (MRAs) were used in 92.2, 92.7, and 67.0% of patients, respectively. When reasons for non-adherence were considered, the real rate of undertreatment accounted for 3.2, 2.3, and 5.4% of the cases, respectively. About 30% of patients received the target dosage of these drugs, but a documented reason for not achieving the target dosage was reported in almost two-thirds of them. The more relevant reasons for non-implantation of a device, when clinically indicated, were related to doctor uncertainties on the indication, patient refusal, or logistical/cost issues. CONCLUSION: This pan-European registry shows that, while in patients with acute HF, a large heterogeneity of treatments exists, drug treatment of chronic HF can be considered large...