title: Adherence to the ESC Heart Failure Treatment Guidelines in Spain: ESC Heart Failure Long-term Registry.
abstract: OBJECTIVE
  To estimate the percentage of heart failure patients in Spain that received the European Society of Cardiology recommended treatments, and in those that did not, to determine the reasons why.
  
  
  METHODS
  The study included 2834 consecutive ambulatory patients with heart failure from 27 Spanish hospitals. We recorded general information, the treatment indicated, and the reasons why it was not prescribed in some cases. In patients who met the criteria to receive a certain drug, true undertreatment was defined as the percentage of patients who, without justification, did not receive the drug.
  
  
  RESULTS
  In total, 92.6% of ambulatory patients with low ejection fraction received angiotensin converting enzyme inhibitors or angiotensin receptor blockers, 93.3% beta-blockers, and 74.5% mineralocorticoid receptor antagonists. The true undertreatment rates were 3.4%, 1.8%, and 19.0%, respectively. Target doses were reached in 16.2% of patients receiving angiotensin converting enzyme inhibitors, 23.3% of those with angiotensin receptor blockers, 13.2% of those prescribed beta-blockers, and 23.5% of those with mineralocorticoid receptor antagonists. Among patients who could benefit from ivabradine, 29.1% received this drug. In total, 36% of patients met the criteria for defibrillator implantation and 90% of them had received the device or were scheduled for implantation, whereas 19.6% fulfilled the criteria for resynchronization therapy and 88.0% already had or would soon have the device. In patients who met the criteria, but did not undergo device implantation, the reasons were not cost-related.
  
  
  CONCLUSIONS
  When justified reasons for not administering heart failure drugs were taken into account, adherence to the guideline recommendations was excellent. Exclusive use of the percentage of treated patients is a poor indicator of the quality of healthcare in heart failure. Measures should be taken to improve the attainment of optimal dosing in each patient.
authors.affiliation: Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade da Coruña (UDC), A Coruña, Spain. Electronic address: marisa.crespo.leiro@sergas.es.
authors.forename: María G
authors.initials: MG
authors.lastname: Crespo-Leiro
authors.affiliation: Unidad de Insuficiencia Cardiaca Avanzada, Trasplante e Hipertensión Pulmonar, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Segovia-Cubero
authors.affiliation: Unidad de Insuficiencia Cardiaca Avanzada y Trasplante, Servicio de Cardiología, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: José
authors.initials: J
authors.lastname: González-Costello
authors.affiliation: Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes-Genis
authors.affiliation: Unidad de Insuficiencia Cardiaca, Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain.
authors.forename: Silvia
authors.initials: S
authors.lastname: López-Fernández
authors.affiliation: Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Eulàlia
authors.initials: E
authors.lastname: Roig
authors.affiliation: Unidad de Insuficiencia Cardiaca Avanzada y Trasplante, Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain.
authors.forename: Marisa
authors.initials: M
authors.lastname: Sanz-Julve
authors.affiliation: Servicio de Cardiología, Hospital Universitario Virgen Macarena, Seville, Spain.
authors.forename: Carla
authors.initials: C
authors.lastname: Fernández-Vivancos
authors.affiliation: Unidad de Gestión del Corazón y Enfermedades Cardiovasculares, Servicio de Cardiología, Hospital Regional Universitario Carlos Haya, Málaga, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: de Mora-Martín
authors.affiliation: Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Área de Gestión Clínica del Corazón, Hospital Universitario Virgen de la Victoria, Málaga, Spain.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: García-Pinilla
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Varela-Román
authors.affiliation: Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Almenar-Bonet
authors.affiliation: Servicio de Cardiología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lara-Padrón
authors.affiliation: Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: de la Fuente-Galán
authors.affiliation: Unidad de Insuficiencia Cardiaca y Trasplante, Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Delgado-Jiménez
mesh_terms: D000368:Aged; D002309:Cardiology / Q000379:methods*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012042:Registries; D012955:Societies, Medical; D013030:Spain; D013997:Time Factors
keywords: Cardiac resynchronization therapy; Clinical practice guidelines; Desfibrilador implantable; Guías de práctica clínica; Heart failure; Implantable defibrillator; Insuficiencia cardiaca; Registro; Registry; Terapia de resincronización cardiaca; Tratamiento; Treatment