SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real World (SUGAR): a multi-center, retrospective, observational study.
BACKGROUND
Clinical practice guidelines have been slowly and inconsistently applied in clinical practice, and certain evidence-based, guideline-driven therapies for heart failure (HF) have been significantly underused. The purpose of this study was to survey guideline compliance and its effect on clinical outcomes in the treatment of systolic HF in Korea.


RESULTS
The SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real World (SUGAR) trial was a multi-center, retrospective, observational study on subjects with systolic HF (ejection fraction <45%) admitted to 23 university hospitals. The guideline adherence indicator (GAI) was defined as a performance measure on the basis of 3 pharmacological classes: angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), beta-blocker (BB), and aldosterone antagonist (AA). Based on the overall adherence percentage, subjects were divided into 2 groups: those with good guideline adherence (GAI ≥50%) and poor guideline adherence (GAI <50%). We included 1319 regional participants as representatives of the standard population from the Korean national census in 2008. Adherence to drugs at discharge was as follows: ACEI or ARB, 89.7%; BB, 69.2%; and AA, 65.9%. Overall, 82.7% of the patients had good guideline adherence. Overall mortality and re-hospitalization rates at 1 year were 6.2% and 37.4%, respectively. Survival analysis by log-rank test showed a significant difference in event-free survival rate of mortality (94.7% vs. 89.8%, p = 0.003) and re-hospitalization (62.3% vs. 56.4%, p = 0.041) between the good and poor guideline-adherence groups.


CONCLUSIONS
Among patients with systolic HF in Korea, adherence to pharmacologic treatment guidelines as determined by performance measures, including prescription of ACEI/ARB and BB at discharge, was associated with improved clinical outcomes.
Division of Cardiology, Yonsei University Wonju Severance Christian Hospital, Wonju, Korea.
Byung-Su
BS
Yoo
Division of Cardiology, Yonsei University Severance Hospital, Seoul, Korea.
Jaewon
J
Oh
Division of Cardiology, Gangnam Severance Hospital, Seoul, Korea.
Bum-Kee
BK
Hong
Division of Cardiology, Gangneung Asan Hospital, Gangneung, Korea.
Dae-Hee
DH
Shin
Division of Cardiology, Konyang University Hospital, Daejeon, Korea.
Jang-Ho
JH
Bae
Division of Cardiology, Kyungpook National University Hospital, Daegu, Korea.
Dong Heon
DH
Yang
Division of Cardiology, Korea University Anam Hospital, Seoul, Korea.
Wan-Joo
WJ
Shim
Division of Cardiology, Keimyung University Dongsan Hospital, Daegu, Korea.
Hyung-Seop
HS
Kim
Division of Cardiology, Busan Veterans Hospital, Busan, Korea.
Su-Hong
SH
Kim
Division of Cardiology, Samsung Medical Center, Seoul, Korea.
Jin-Oh
JO
Choi
Division of Cardiology, Sungkyunkwan University Samsung Changwon Hospital, Changwon, Korea.
Woo-Jung
WJ
Chun
Division of Cardiology, Inje University Sanggye Paik Hospital, Seoul, Korea.
Choong-Won
CW
Go
Division of Cardiology, Seoul National University Hospital, Seoul, Korea.
Hyun-Jae
HJ
Kang
Division of Cardiology, Seoul St. Mary's Hospital of the Catholic University of Korea, Seoul, Korea.
Sang Hong
SH
Baek
Division of Cardiology, St. Carollo Hospital, Suncheon, Korea.
Jang-Hyun
JH
Cho
Division of Cardiology, Sejong General Hospital, Bucheon, Korea.
Suk-Keun
SK
Hong
Division of Cardiology, Ajou University Hospital, Suwon, Korea.
Joon-Han
JH
Shin
Division of Cardiology, Wongwang University Hospital, Iksan, Korea.
Seok-Kyu
SK
Oh
Division of Cardiology, Ewha Womans University Mokdong Hospital, Seoul, Korea.
Wook-Bum
WB
Pyun
Division of Cardiology, Inha University Hospital, Incheon, Korea.
Jun
J
Kwan
Division of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
Young-Joon
YJ
Hong
Division of Cardiology, Chungnam National University Hospital, Daejeon, Korea.
Jin-Ok
JO
Jeong
Division of Cardiology, Yonsei University Severance Hospital, Seoul, Korea.
Seok-Min
SM
Kang
Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, Korea.
Dong-Ju
DJ
Choi
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003625:Data Collection / Q000379:methods; D019317:Evidence-Based Medicine / Q000379:methods / Q000639:trends; D054143:Heart Failure, Systolic / Q000188:drug therapy; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D056910:Republic of Korea; D012189:Retrospective Studies; D012737:Sex Factors; D012959:Socioeconomic Factors; D016896:Treatment Outcome; D016903:Drug Monitoring
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists