PMID- 15827061
OWN - NLM
STAT- MEDLINE
DCOM- 20060110
LR  - 20220309
IS  - 0195-668X (Print)
IS  - 0195-668X (Linking)
VI  - 26
IP  - 16
DP  - 2005 Aug
TI  - Adherence to guidelines is a predictor of outcome in chronic heart failure: the 
      MAHLER survey.
PG  - 1653-9
AB  - 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, spironolactone, diuretics, and cardiac 
      glycosides and GAIs (GAI3 adherence to first three classes of heart failure 
      medication, GAI5 adherence to five classes). In the study, 1410 evaluable 
      patients (mean age 69, 69% males, 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 (GAI3) and 63% (GAI5) and was better for ACE-I (88%) or 
      diuretics (82%) than for cardiac glycosides (52%), beta-blockers (58%), and 
      spironolactone (36%). In the three tertiles 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 GAI3 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.
FAU - Komajda, Michel
AU  - Komajda M
AD  - Department of Cardiology, Pitie-Salpetriere Hospital, 47-83 Boulevard de 
      l'Hopital, 75651 Paris Cedex 13, France. michel.komajda@psl.ap-hop-paris.fr
FAU - Lapuerta, Pablo
AU  - Lapuerta P
FAU - Hermans, Nancy
AU  - Hermans N
FAU - Gonzalez-Juanatey, Jose Ramon
AU  - Gonzalez-Juanatey JR
FAU - van Veldhuisen, Dirk J
AU  - van Veldhuisen DJ
FAU - Erdmann, Erland
AU  - Erdmann E
FAU - Tavazzi, Luigi
AU  - Tavazzi L
FAU - Poole-Wilson, Philip
AU  - Poole-Wilson P
FAU - Le Pen, Claude
AU  - Le Pen C
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20050412
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
RN  - 0 (Cardiac Glycosides)
RN  - 0 (Diuretics)
SB  - IM
CIN - Eur Heart J. 2006 Jan;27(2):247-8. PMID: 16319087
MH  - Adrenergic beta-Antagonists/economics/*therapeutic use
MH  - Aged
MH  - Angiotensin-Converting Enzyme Inhibitors/economics/*therapeutic use
MH  - Cardiac Glycosides/economics/genetics/*therapeutic use
MH  - Diuretics/economics/*therapeutic use
MH  - Female
MH  - *Guideline Adherence/economics
MH  - Health Surveys
MH  - Heart Failure/*drug therapy
MH  - Humans
MH  - Male
MH  - Practice Guidelines as Topic
MH  - Practice Patterns, Physicians'
MH  - Prospective Studies
MH  - Treatment Outcome
EDAT- 2005/04/14 09:00
MHDA- 2006/01/13 09:00
CRDT- 2005/04/14 09:00
PHST- 2005/04/14 09:00 [pubmed]
PHST- 2006/01/13 09:00 [medline]
PHST- 2005/04/14 09:00 [entrez]
AID - ehi251 [pii]
AID - 10.1093/eurheartj/ehi251 [doi]
PST - ppublish
SO  - Eur Heart J. 2005 Aug;26(16):1653-9. doi: 10.1093/eurheartj/ehi251. Epub 2005 Apr 
      12.