title: Adherence to evidence-based guidelines for heart failure in physicians and their patients: lessons from the Heart Failure Adherence Retention Trial (HART).
abstract: The Heart Failure Adherence and Retention Trial (HART) provided an opportunity to determine adherence to evidence-based guidelines (EBG) in patients with heart failure (HF). Ten hospitals were the source of 692 patients with HF (EF < 40%). Physicians of patients with HF were classified as adherent to EBG if the patient chart audit showed they were on a beta-blocker, ACE-inhibitor (ACE-I), or angiotensin receptor blocker (ARB). Patients were classified as adherent to EBG if MEMS pill caps were used appropriately more than 80% of the time. Sixty-three percent of physicians prescribed evidence-based medications that were adherent to clinical practice guidelines. New York Heart Association (NYHA) III patients were less likely to be adherent (P < 0.001), as were those with renal disease (P < 0.001) and asthmatics (P < 0.001). Nonadherent physicians were less likely to treat patients with beta-blockers (39% vs 98%, P < 0.001) and ACE-I or ARBs (71% vs 98% P < 0.001). Thirty-seven percent of patients prescribed evidence-based therapy failed to use the MEMS pill cap bottles appropriately and were more likely a minority or higher NYHA class. Adherence to evidence-based therapy is less than optimal in HF patients based on a combination of both physician and patient nonadherence.
authors.affiliation: Section of Cardiology, Rush University Medical Center, Chicago, IL 60612-3833, USA. james_calvin@rush.edu
authors.forename: James E
authors.initials: JE
authors.lastname: Calvin
authors.forename: Sujata
authors.initials: S
authors.lastname: Shanbhag
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Avery
authors.forename: John
authors.initials: J
authors.lastname: Kane
authors.forename: Dejuran
authors.initials: D
authors.lastname: Richardson
authors.forename: Lynda
authors.initials: L
authors.lastname: Powell
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D016009:Chi-Square Distribution; D002641:Chicago; D016001:Confidence Intervals; D019317:Evidence-Based Medicine / Q000379:methods*; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016903:Drug Monitoring
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors