PMID- 18046524 OWN - NLM STAT- MEDLINE DCOM- 20081125 LR - 20211020 IS - 1861-0684 (Print) IS - 1861-0684 (Linking) VI - 97 IP - 4 DP - 2008 Apr TI - Guideline adherence for pharmacotherapy of chronic systolic heart failure in general practice: a closer look on evidence-based therapy. PG - 244-52 AB - BACKGROUND: There is robust evidence for effective pharmacotherapy of chronic (systolic) heart failure (CHF) which has led to the creation of guidelines, but many surveys evaluating CHF treatment show an under-utilisation of relevant drugs, while setting and patient population appear to be crucial for adequate appraisal of treatment patterns. AIMS: To evaluate the guideline adherence (GA) of general practitioners (GPs) in a well-defined patient population with CHF in primary care (PC). METHODS: A cross-sectional analysis was performed with the data of 167 patients enrolled in 37 GP practices (Germany) with documented left ventricular systolic dysfunction (LVEF: 33.3 +/- 6.9%). GA was assessed as usual (prescribing "yes" or "no"), through evaluation of target dosing, while adjusting for potential clinical contraindications, and through a modified Guideline Adherence Indicator-3 (mGAI-3), which assesses three relevant groups of substances according to New York Heart Association (NYHA) functional class: ACE-Inhibitors (ACE-I) or angiotensin receptor blockers (ARB), beta-blockers (BB) and aldosterone-antagonists (AA). RESULTS: Prescription rates for ACE-I/ARB, BB or both were 80%, 75% and 62%, respectively. The proportion of target doses reached for ACE-I was 16%, for BB only 8%. When adjusted for potential (mainly relative) contraindications (COPD, heart rate <60/min, hypotension, hyperkalaemia and renal dysfunction), the percentage of target doses reached increased to 49% for ACE-I/ARBs and 46% for BB. Application of the mGAI-3 showed moderate to perfect GA for usual assessment, proportion of target dose reached and adjusted in 83%, 16% and 55% of the patients, respectively. CONCLUSION: In the context of this patient and doctor setting, life-saving treatment was provided above average when assessed by usual criteria. The application of additional criteria showed further room for improvement. Future interventions aiming at optimisation should be tailored to the needs of doctors and patients likewise. FAU - Peters-Klimm, F AU - Peters-Klimm F AD - Department of General Practice and Health Services Research, University Hospital Heidelberg, Vossstrasse 2, Heidelberg 69115, Germany. frank.peters@med.uni-heidelberg.de FAU - Muller-Tasch, T AU - Muller-Tasch T FAU - Schellberg, D AU - Schellberg D FAU - Remppis, A AU - Remppis A FAU - Barth, A AU - Barth A FAU - Holzapfel, N AU - Holzapfel N FAU - Junger, J AU - Junger J FAU - Herzog, W AU - Herzog W FAU - Szecsenyi, J AU - Szecsenyi J LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20071128 PL - Germany TA - Clin Res Cardiol JT - Clinical research in cardiology : official journal of the German Cardiac Society JID - 101264123 RN - 0 (Adrenergic beta-Antagonists) RN - 0 (Angiotensin-Converting Enzyme Inhibitors) RN - 0 (Mineralocorticoid Receptor Antagonists) SB - IM MH - Adrenergic beta-Antagonists/standards/therapeutic use MH - Adult MH - Aged MH - Aged, 80 and over MH - Angiotensin-Converting Enzyme Inhibitors/standards/therapeutic use MH - Chronic Disease MH - Cross-Sectional Studies MH - Evidence-Based Medicine/standards MH - Family Practice/*statistics & numerical data MH - Female MH - *Guideline Adherence MH - Heart Failure, Systolic/*drug therapy MH - Humans MH - Male MH - Middle Aged MH - Mineralocorticoid Receptor Antagonists/standards/therapeutic use MH - Practice Guidelines as Topic MH - Practice Patterns, Physicians'/*statistics & numerical data MH - Primary Health Care/standards EDAT- 2007/11/30 09:00 MHDA- 2008/12/17 09:00 CRDT- 2007/11/30 09:00 PHST- 2007/04/23 00:00 [received] PHST- 2007/10/17 00:00 [accepted] PHST- 2007/11/30 09:00 [pubmed] PHST- 2008/12/17 09:00 [medline] PHST- 2007/11/30 09:00 [entrez] AID - 10.1007/s00392-007-0617-6 [doi] PST - ppublish SO - Clin Res Cardiol. 2008 Apr;97(4):244-52. doi: 10.1007/s00392-007-0617-6. Epub 2007 Nov 28.