title: Adherence to guidelines improves the clinical outcome of patients with acutely decompensated heart failure.
abstract: BACKGROUND
  Acutely decompensated heart failure/pulmonary edema is one of the most common medical problems in clinical practice. Approximately 500 patients are admitted to Rambam Health Care Campus yearly with the diagnosis of ADHF/PE. As a result, Rambam established local instructions and guidelines for the treatment of ADHF/PE based on the guidelines published by the American Heart Association, American College of Cardiology and The European Society of Cardiology.
  
  
  OBJECTIVE
  To examine whether adherence to guidelines improves the outcome of patients with ADHF/PE in internal medicine wards.
  
  
  METHODS
  Data were collected from the charts of 78 patients admitted to Rambam with ADHF/PE and were compared to a matched historic cohort.
  
  
  RESULTS
  Echocardiography was performed more commonly in the study group patients as compared to the control group, 85% vs. 37.7% respectively (P = 0.0001). In patients who were treated according to the guidelines, angiotensin-converting enzyme inhibitors and beta-blockers were prescribed more commonly as compared to the control group. The 3 month mortality rate was significantly lower in the study group (P = 0.021).
  
  
  CONCLUSIONS
  Adherence to guidelines for treatment of ADHF/PE decreased the short-term mortality and increased the use of medications known to reduce mortality and morbidity in patients with systolic heart failure. Echocardiography is an important tool to guide treatment of ADHF/PE.
authors.affiliation: Department of Internal Medicine B, Rambam Health Care Campus, Haifa, Israel. e_braun@rambam.health.gov.il
authors.forename: Eyal
authors.initials: E
authors.lastname: Braun
authors.forename: Keren
authors.initials: K
authors.lastname: Landsman
authors.forename: Robert
authors.initials: R
authors.lastname: Zuckerman
authors.forename: Gidon
authors.initials: G
authors.lastname: Berger
authors.forename: Ahuva
authors.initials: A
authors.lastname: Meilik
authors.forename: Zaher S
authors.initials: ZS
authors.lastname: Azzam
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors