title: ALERT-HF: adherence to guidelines in the treatment of patients with chronic heart failure.
abstract: BACKGROUND
  The prognosis of chronic heart failure (CHF) may be substantially improved by strict adherence to current therapeutic guidelines.
  
  
  OBJECTIVE
  To assess the adherence to current guidelines, 660 CHF patients consecutively referred to the ARCA (Associazioni Regionali Cardiologi Ambulatoriali Campania) cardiologists were evaluated. As indicators of adherence to the guidelines, we considered use of angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers, beta-blockers, loop diuretics, aldosterone antagonists, digoxin, anticoagulant therapy, and implantation of cardiac devices.
  
  
  RESULTS
  The adherence to guidelines has been characterized in patients with reduced ejection fraction, who represent the majority in the ALERT-HF (Adherence to Guidelines in the Treatment of patients with Chronic Heart Failure) trial and in whom the current guidelines are well defined and shared. Among 528 patients affected by CHF with ejection fraction 45% or less, 399 (75.6%) were treated with a beta-blocker, 282 (53.4%) received an angiotensin-converting enzyme inhibitor and 199 (37.7%) an angiotensin receptor blocker. Four hundred and sixty-nine patients (88.9%) used loop diuretics, but only 163 patients (30.9%) an aldosterone antagonist. Among 148 patients with atrial fibrillation, 95 (64.2%) were treated with anticoagulants. As few as 31 patients received cardiac electrical stimulation devices: 10 patients were implanted with a cardioverter-defibrillator and 21 received a device for cardiac resynchronization therapy.
  
  
  CONCLUSIONS
  The study reveals poor adherence to current therapeutic guidelines for CHF, particularly with regard to aldosterone antagonists and anticoagulant therapy in the presence of atrial fibrillation. Even poorer is the adherence to guidelines as regards the use of implantable cardiac devices. The underlying reasons are discussed in relation to the data of other registries.
authors.affiliation: aA.R.C.A. (Associazioni Regionali Cardiologi Ambulatoriali), Campania, Via M. Testa, Salerno bLaboratorio di Elettrofisiologia, Clinica Mediterranea, Via Orazio, Naples cDepartment of Cardiology and Cardiac Surgery, University Hospital 'Scuola Medica Salernitana' Salerno dDepartment of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy eBoston Scientific Therapy Development, via Forlanini 23, Milan fDepartment of Translational Medical Sciences, University Federico II, Via Sergio Pansini, Naples, Italy *ALERT-HF Investigators: Alma Giovanni; Autiero Ciro; Carbone Vincenzo; Cardone Andrea; Carella Giovanni; Carotenuto Andrea; Ciotola Ciro; Di Giorgio Massimo; Ferrara Ferdinando; Fortunato Salvatore; Iandolo Alessandro; Lerro Luciana; Montefusco Domenico; Murolo Sabato; Olivares Maurizio; Soreca Silvia.
authors.forename: Guarnaccia
authors.initials: G
authors.lastname: Franco
authors.forename: Fimiani
authors.initials: F
authors.lastname: Biagio
authors.forename: Zito Giovanni
authors.initials: ZG
authors.lastname: Battista
authors.forename: Antonio
authors.initials: A
authors.lastname: De Simone
authors.forename: De Simone
authors.initials: de S
authors.lastname: Antonio
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Stabile
authors.forename: Stabile
authors.initials: S
authors.lastname: Giuseppe
authors.forename: Edoardo
authors.initials: E
authors.lastname: Bossone
authors.forename: Bossone
authors.initials: B
authors.lastname: Edoardo
authors.forename: Ercole
authors.initials: E
authors.lastname: Volpe
authors.forename: Volpe
authors.initials: V
authors.lastname: Ercole
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bosso
authors.forename: Bosso
authors.initials: B
authors.lastname: Giorgio
authors.forename: Luigi
authors.initials: L
authors.lastname: Saccà
authors.forename: Saccà
authors.initials: S
authors.lastname: Luigi
authors.forename: Ugo
authors.initials: U
authors.lastname: Oliviero
authors.forename: Oliviero
authors.initials: O
authors.lastname: Ugo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000008:administration & dosage; D002908:Chronic Disease; D015897:Comorbidity; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007558:Italy; D008297:Male; D017410:Practice Guidelines as Topic; D055656:Prescriptions / Q000706:statistics & numerical data; D011379:Prognosis; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology
chemical_list: D002317:Cardiovascular Agents