Gap between guidelines and clinical practice in heart failure with reduced ejection fraction: Results from TSOC-HFrEF registry

被引：47

作者：

Chang, Hung-Yu ^{[1
,2
]}

Wang, Chun-Chieh ^{[3
]}

Wei, Jeng ^{[1
]}

Chang, Chong-Yi ^{[1
]}

Chuang, Yi-Cheng ^{[1
]}

Huang, Chien-Long ^{[1
]}

Chong, Eric ^{[4
]}

Lin, Jiunn-Lee ^{[5
]}

Mar, Guang-Yuan ^{[6
]}

Chan, Kuei-Chuan ^{[7
]}

Kuo, Jen-Yuan ^{[8
]}

Wang, Ji-Hung ^{[9
]}

Chen, Zhih-Chemg ^{[10
]}

Tseng, Wei-Kung ^{[11
]}

Cherng, Wen-Jin ^{[12
]}

Yin, Wei-Hsian ^{[1
]}

机构：

[1] Cheng Hsin Gen Hosp, Heart Ctr, 45 Cheng Hsin St, Taipei 112, Taiwan

[2] Natl Yang Ming Univ, Sch Med, Fac Med, Taipei, Taiwan

[3] Chang Gung Mem Hosp, Div Cardiol, Taoyuan, Taiwan

[4] Jurong Hlth Pte Ltd, Div Cardiol, Singapore, Singapore

[5] Natl Taiwan Univ Hosp, Div Cardiol, Dept Internal Med, Taipei, Taiwan

[6] Kaohsiung Vet Gen Hosp, Div Cardiol, Kaohsiung, Taiwan

[7] Chung Shan Med Univ Hosp, Dept Internal Med, Taichung, Taiwan

[8] MacKay Mem Hosp, Div Cardiol, Dept Internal Med, Taipei, Taiwan

[9] Buddhist Tzu Chi Med Fdn, Hualien Tzu Chi Hosp, Div Cardiol, Hualien, Taiwan

[10] Chimei Med Ctr, Div Cardiovasc Med, Tainan, Taiwan

[11] E Da Hosp, Div Cardiol, Dept Internal Med, Kaohsiung, Taiwan

[12] Chang Gung Mem Hosp, Div Cardiol, Dept Internal Med, Keelung, Taiwan

来源：

JOURNAL OF THE CHINESE MEDICAL ASSOCIATION | 2017年 / 80卷 / 12期

关键词：

Adherence; Beta-blocker; Guidelines; Heart failure; Renin-angiotensin blockade; Taiwan; OUTCOMES; MANAGEMENT; MORBIDITY; MORTALITY; SURVIVAL; CARDIOLOGISTS; POPULATION; DIAGNOSIS; PRACTITIONERS; BLOCKERS;

D O I：

10.1016/j.jcma.2017.04.011

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background: Heart failure (HF) is a global health problem. Guidelines for the management of HF have been established in Western countries and in Taiwan. However, data from the Taiwan Society of Cardiology-Heart Failure with reduced Ejection Fraction (TSOC-HFrEF) registry showed suboptimal prescription of guideline-recommended medications. We aimed to analyze the reason of non-prescription and clinical outcomes as a result of under-prescription of medications. Methods: A total of 1509 patients hospitalized for acute HFrEF were recruited in 21 hospitals in Taiwan by the end of October 2014. Prescribed guideline recommended medications and other relevant clinical parameters were collected and analyzed at discharge and 1 year after index hospitalization. Results: At discharge, 62% of patients were prescribed with either angiotensin-converting enzyme-inhibitors (ACEI) or angiotensin receptor blockers (ARB); 60% were prescribed with beta-blockers and 49% were prescribed with mineralocorticoid receptor antagonists (MRA). The proportions of patients at >= 50% of the target dose for ACEI/ARB, beta-blockers and MRA were 24.4%, 20.6%, 86.2%, respectively. At 1-year follow-up, dosages of ACEI/ARB and MRA were up-titrated in about one-fourth patients, and dosages of beta-blocker were up-titrated in about 40% patients. One-year mortality rate was lowest in patients who received at least 2 classes of guideline-recommended medications with >= 50% of the target dose, and highest in those who received 0 or 1 class of medications. Conclusion: The TSOC-HFrEF registry demonstrated the under-prescription of guideline-recommended medications and reluctance of physicians to up-titrate medications to target dose. Action plan needs be formulated in order to improve physician's adherence to HF guidelines. Copyright (C) 2017, the Chinese Medical Association. Published by Elsevier Taiwan LLC.

引用

页码：750 / 757

页数：8

共 35 条

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