title: Implementation of evidence-based therapy in patients with systolic heart failure from 1998-2000.
abstract: BACKGROUND
  In recent years, the incidence of systolic heart failure has increased. Besides a complete revascularization, guideline-based medication represents the most effective therapeutic approach.
  
  
  OBJECTIVE
  Analysis of adherence of guideline-recommended and actual medication during inpatient cardiac rehabilitation as well as under subsequent outpatient conditions.
  
  
  METHODS
  From 01/1998 to 12/ 2000, 1346 consecutive patients (64 +/- 10 years, 73% male, LVEF 36.3 +/- 8%, 88% ischemic, 6.7% valvular cardiomyopathy, 5.3% other causes, 11.8% atrial fibrillation) were included in a singlecenter prospective register. Medication was recorded at discharge and after the follow-up period of 731 +/- 215 days. Trends in prescription rates were analyzed based on nonparametric correlations (Spearman's-Rho). Changes in medication from in- to outpatient settings were analyzed using exact McNemar test.
  
  
  RESULTS
  At discharge 75.3% (67.9%/68.9%/ 86.6% in 1998/1999/2000, p <0.001) of the patients were treated as recommended. This rate dropped to 68.3% at followup (p <0.0001). Mortality within the follow-up period was low (12.6%).
  
  
  CONCLUSIONS
  It could be shown that from 1998 to 2000 inpatient guideline conformity was implementable adequately. Outpatient conformity was significantly lower. Although a high proportion of correctly prescribed CHF medication could be demonstrated, a further effort to improve guideline adherence in the management of heart failure patients is desirable.
authors.affiliation: Klinik am See Ruedersdorf/Berlin, Seebad 84, 15562, Ruedersdorf/Berlin, Germany. rona.reibis@klinikamsee.com
authors.forename: R
authors.initials: R
authors.lastname: Reibis
authors.forename: C
authors.initials: C
authors.lastname: Dovifat
authors.forename: R
authors.initials: R
authors.lastname: Dissmann
authors.forename: B
authors.initials: B
authors.lastname: Ehrlich
authors.forename: S
authors.initials: S
authors.lastname: Schulz
authors.forename: K
authors.initials: K
authors.lastname: Stolze
authors.forename: K
authors.initials: K
authors.lastname: Wegscheider
authors.forename: H
authors.initials: H
authors.lastname: Völler
mesh_terms: D000368:Aged; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007297:Inpatients / Q000706:statistics & numerical data; D008297:Male; D010045:Outpatients / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents