title: Use of evidence-based therapy and survival in heart failure in Sweden 2003-2012.
abstract: In heart failure with reduced ejection fraction, drug and device therapy improve survival. We studied contemporary trends in utilization of evidence-based therapy and associated survival.
  
  
  
  We studied 5908 patients with NYHA class II-IV heart failure, EF <30%, and duration of heart failure ≥6 months registered in the Swedish Heart Failure Registry between 2003 and 2012. Regression using generalized estimation equations was used to examine temporal trends in crude and risk-adjusted rates of utilization of evidence-based heart failure therapy and 30-day, 1-year, and 3-year survival. In 2003 vs. 2012, the risk-adjusted use of therapy and P-values for trends were as follows: renin-angiotensin system antagonists, 88% vs. 86% (P = 0.091); beta-blockers, 85% vs. 93% (P = 0.008); mineralocorticoid receptor antagonists, 53% vs. 42% (P < 0.001); CRT, 2.4% vs. 8.2% (P = 0.074); and implantable cardioverter-defibrillators, 4.0% vs. 10.7% (P = 0.004). During the same period, the risk-adjusted 30-day, 1-year, and 3-year survival was 92% vs. 94% (P = 0.532), 81% vs. 77% (P = 0.260), and 58% vs. 54% (P = 0.425), respectively.
  
  
  
  In this large nationwide registry, over the last decade the use of evidence-based drug therapy was high and remained stable over time, but, despite an increased use of device therapy, the absolute use was poor. This was associated with an absence of improvement in survival. The improvements in therapy and prognosis over the last generation may be levelling off, and efforts should be directed at improving implementation of evidence-based therapy.
authors: Karolinska Institutet, Department of Medicine, Stockholm, Sweden.|Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden.
authors: Tonje
authors: T
authors: Thorvaldsen
authors: Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
authors: Lina
authors: L
authors: Benson
authors: Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
authors: Ulf
authors: U
authors: Dahlström
authors: Karolinska Institutet, Department of Medicine, Stockholm, Sweden.
authors: Magnus
authors: M
authors: Edner
authors: Karolinska Institutet, Department of Medicine, Stockholm, Sweden.|Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden.
authors: Lars H
authors: LH
authors: Lund
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D058406:Cardiac Resynchronization Therapy; D017147:Defibrillators, Implantable; D019317:Evidence-Based Medicine; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D012042:Registries; D015996:Survival Rate; D013548:Sweden
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000451:Mineralocorticoid Receptor Antagonists
keywords: Evidence-based therapy; Guidelines; Heart failure; Implementation; Outcomes; Utilization