title: Clinical impact of adherence to guidelines on the outcome of chronic heart failure in Japan.
abstract: The impact of guideline adherence on clinical outcomes in the management of chronic heart failure (CHF) has never been evaluated in Japan. We investigated outcomes in 92 consecutive CHF patients admitted to Kitasato University Hospital in 2004-2006 for HF exacerbation with a left ventricular ejection fraction < or = 40% by the use of class I drugs for pump-failure, as recommended in the Japanese Circulation Society guideline. Drugs, namely angiotensin-converting enzyme inhibitors (ACEI), beta-blockers (BB), spironolactone, diuretics, and cardiac glycosides were administered to 64.1%, 59.8%, 28.2%, 96.7%, and 68.0% of patients, respectively. Patients for whom adherence to the prescription of ACEI and BB as first-line agents was high had significantly and independently better prognostic outcomes for cardiac events (P = 0.0036) as well as subsequent improvements in clinical surrogate markers for HF status such as NYHA class and BNP. Addition of the 3 latter drugs to the prescription of ACEI and BB did not affect the superiority of ACE plus BB in improving the long-term prognosis. We have demonstrated that adherence to treatment guidelines for CHF is a significant predictor of subsequent cardiac events in actual practice in Japan. An effective means of improving adherence to current guideline standards of care for CHF has yet to be established.
authors: Department of Cardio-angiology, Kitasato University School of Medicine, Kitasato, Kanagawa, Japan.
authors: Tsutomu
authors: T
authors: Ohsaka
authors: Takayuki
authors: T
authors: Inomata
authors: Takashi
authors: T
authors: Naruke
authors: Hisahito
authors: H
authors: Shinagawa
authors: Toshimi
authors: T
authors: Koitabashi
authors: Mototsugu
authors: M
authors: Nishii
authors: Ichiro
authors: I
authors: Takeuchi
authors: Hitoshi
authors: H
authors: Takehana
authors: Tohru
authors: T
authors: Izumi
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D017408:Guidelines as Topic; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors