title: Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12,440 patients of the ESC Heart Failure Long-Term Registry.
abstract: OBJECTIVE
  To evaluate how recommendations of European guidelines regarding pharmacological and non-pharmacological treatments for heart failure (HF) are adopted in clinical practice.
  
  
  RESULTS
  The ESC-HF Long-Term Registry is a prospective, observational study conducted in 211 Cardiology Centres of 21 European and Mediterranean countries, members of the European Society of Cardiology (ESC). From May 2011 to April 2013, a total of 12,440 patients were enrolled, 40.5% with acute HF and 59.5% with chronic HF. Intravenous treatments for acute HF were heterogeneously administered, irrespective of guideline recommendations. In chronic HF, with reduced EF, renin-angiotensin system (RAS) blockers, beta-blockers, and mineralocorticoid antagonists (MRAs) were used in 92.2, 92.7, and 67.0% of patients, respectively. When reasons for non-adherence were considered, the real rate of undertreatment accounted for 3.2, 2.3, and 5.4% of the cases, respectively. About 30% of patients received the target dosage of these drugs, but a documented reason for not achieving the target dosage was reported in almost two-thirds of them. The more relevant reasons for non-implantation of a device, when clinically indicated, were related to doctor uncertainties on the indication, patient refusal, or logistical/cost issues.
  
  
  CONCLUSIONS
  This pan-European registry shows that, while in patients with acute HF, a large heterogeneity of treatments exists, drug treatment of chronic HF can be considered largely adherent to recommendations of current guidelines, when the reasons for non-adherence are taken into account. Observations regarding the real possibility to adhere fully to current guidelines in daily clinical practice should be seriously considered when clinical practice guidelines have to be written.
authors: ANMCO Research Center, Florence, Italy.
authors: Aldo P
authors: AP
authors: Maggioni
authors: Stefan D
authors: SD
authors: Anker
authors: Ulf
authors: U
authors: Dahlström
authors: Gerasimos
authors: G
authors: Filippatos
authors: Piotr
authors: P
authors: Ponikowski
authors: Faiez
authors: F
authors: Zannad
authors: Offer
authors: O
authors: Amir
authors: Ovidiu
authors: O
authors: Chioncel
authors: Marisa Crespo
authors: MC
authors: Leiro
authors: Jaroslaw
authors: J
authors: Drozdz
authors: Andrejs
authors: A
authors: Erglis
authors: Emir
authors: E
authors: Fazlibegovic
authors: Candida
authors: C
authors: Fonseca
authors: Friedrich
authors: F
authors: Fruhwald
authors: Plamen
authors: P
authors: Gatzov
authors: Eva
authors: E
authors: Goncalvesova
authors: Mahmoud
authors: M
authors: Hassanein
authors: Jaromir
authors: J
authors: Hradec
authors: Ausra
authors: A
authors: Kavoliuniene
authors: Mitja
authors: M
authors: Lainscak
authors: Damien
authors: D
authors: Logeart
authors: Bela
authors: B
authors: Merkely
authors: Marco
authors: M
authors: Metra
authors: Hans
authors: H
authors: Persson
authors: Petar
authors: P
authors: Seferovic
authors: Ahmet
authors: A
authors: Temizhan
authors: Dimitris
authors: D
authors: Tousoulis
authors: Luigi
authors: L
authors: Tavazzi
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000553:Ambulatory Care / Q000592:standards; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002309:Cardiology / Q000592:standards*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data; D004232:Diuretics / Q000627:therapeutic use; D005060:Europe; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D009566:Nitrates / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012042:Registries
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D004232:Diuretics; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000451:Mineralocorticoid Receptor Antagonists; D009566:Nitrates; D010975:Platelet Aggregation Inhibitors
keywords: ACE inhibitors; Beta-blockers; CRT; Heart failure; ICD; MRAs