title: Adherence to guidelines for patients hospitalized with heart failure: a nationwide survey.
abstract: BACKGROUND
  Despite significant advances in the therapy of heart failure, many patients still do not receive optimal treatment.
  
  
  OBJECTIVE
  To document the standard of care that patients hospitalized with HF in Israel received during a 2 month period.
  
  
  METHODS
  The Heart Failure Survey in Israel 2003 was a prospective 2 month survey of patients admitted to all 25 public hospitals in Israel with a diagnosis of HF.
  
  
  RESULTS
  The mean age of the 4102 patients was 73 years and 43% were female. The use of angiotensin-converting enzyme/angiotensin receptor blockers and beta blockers both declined from NYHA class I to IV (68.8% to 50.6% for ACE-inhibitor/ARB and 64.1% to 52.9% for beta blockers, P < 0.001 for comparisons). The percentage of patients by NYHA class taking an ACE-inhibitor or ARB and a beta blocker at hospital discharge also declined from NYHA class I to IV (47.5% to 28.8%, P < 0.002 for comparisons). The strongest predictor of being discharged with an ACE-inhibitor or ARB was the use of these medications at hospital admission. Negative predictors for their usage were age, creatinine, disease severity class, and functional status.
  
  
  CONCLUSIONS
  Despite the dissemination of guidelines many patients did not receive optimal care for HF. Reasons for this discrepancy need to be identified and modified.
authors.affiliation: Department of Internal Medicine F, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel. ajotkowitz@hotmail.com
authors.forename: Alan B
authors.initials: AB
authors.lastname: Jotkowitz
authors.forename: Avi
authors.initials: A
authors.lastname: Porath
authors.forename: Avraham
authors.initials: A
authors.lastname: Shotan
authors.forename: Moshe
authors.initials: M
authors.lastname: Mittelman
authors.forename: Ehud
authors.initials: E
authors.lastname: Grossman
authors.forename: Reuven
authors.initials: R
authors.lastname: Zimlichman
authors.forename: Basil S
authors.initials: BS
authors.lastname: Lewis
authors.forename: Abraham
authors.initials: A
authors.lastname: Caspi
authors.forename: Shmuel
authors.initials: S
authors.lastname: Gottlieb
authors.forename: Moshe
authors.initials: M
authors.lastname: Garty
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D017723:Drug Utilization Review; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006779:Hospitals, Public / Q000592:standards*; D006801:Humans; D007557:Israel; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D017202:Myocardial Ischemia / Q000188:drug therapy / Q000503:physiopathology; D010343:Patient Admission; D010351:Patient Discharge; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011787:Quality of Health Care; D013148:Spironolactone / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone