Adherence to guidelines for patients hospitalized with heart failure: a nationwide survey.
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.
Jotkowitz
Alan B
AB
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
Porath
Avi
A
Shotan
Avraham
A
Mittelman
Moshe
M
Grossman
Ehud
E
Zimlichman
Reuven
R
Lewis
Basil S
BS
Caspi
Abraham
A
Gottlieb
Shmuel
S
Garty
Moshe
M
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
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D004232:Diuretics; D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone