title: Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey.
abstract: OBJECTIVE
  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.
  
  
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Pitie-Salpetriere Hospital, 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France. michel.komajda@psl.ap-hop-paris.fr
authors.forename: Michel
authors.initials: M
authors.lastname: Komajda
authors.forename: Pablo
authors.initials: P
authors.lastname: Lapuerta
authors.forename: Nancy
authors.initials: N
authors.lastname: Hermans
authors.forename: José Ramon
authors.initials: JR
authors.lastname: Gonzalez-Juanatey
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: van Veldhuisen
authors.forename: Erland
authors.initials: E
authors.lastname: Erdmann
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.forename: Philip
authors.initials: P
authors.lastname: Poole-Wilson
authors.forename: Claude
authors.initials: C
authors.lastname: Le Pen
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use*; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use*; D002301:Cardiac Glycosides / Q000191:economics / Q000235:genetics / Q000627:therapeutic use*; D004232:Diuretics / Q000191:economics / Q000627:therapeutic use*; D005260:Female; D019983:Guideline Adherence / Q000191:economics; D006306:Health Surveys; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002301:Cardiac Glycosides; D004232:Diuretics