title: [Impact of guideline adherence on mortality in treatment of left heart failure].
abstract: BACKGROUND
  The German national guidelines on chronic heart failure provide treatment recommendations to physicians and reflect the current level of evidence; however, it is questionable to what extent these recommendations are applied in the routine practice and what the effect of guideline adherence on mortality is.
  
  
  METHODS
  In this study the claims data of a major German health insurance fund collected over a period of 4 years were analyzed. Using binary logistic regression and Cox regression analyses the influence of drug prescriptions, diagnostic measures, influenza vaccination, the New York Heart Association (NYHA) status, the age and gender on mortality were examined.
  
  
  RESULTS
  The study population consisted of 85,465 heart failure patients. Approximately 60 % of the drugs were prescribed according to the guidelines. There was a positive correlation between a higher NYHA status and mortality with an odds ratio (OR) of 3.264. Especially pharmacotherapy with angiotensin-converting enzyme (ACE) inhibitors and beta blockers according to the guidelines was associated with a lower mortality rate (OR 0.448 resp. 0.444). Also patients diagnosed using echocardiography at regular intervals showed a lower risk of dying (OR 0.314).
  
  
  CONCLUSIONS
  The results of this large sample could confirm the results of clinical trials that a therapy according to the guidelines has a significant impact on mortality. By analyzing the claims data evidence was found that in the treatment of heart failure patients the medical results could be improved by adherence to guideline recommendations.
authors.affiliation: Leibniz Universität Hannover, Center for Health Economics Research Hannover (CHERH), Hannover, Deutschland. sn@cherh.de.
authors.forename: S
authors.initials: S
authors.lastname: Neubauer
authors.affiliation: Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie (HTTG), Hannover, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Schilling
authors.affiliation: Leibniz Universität Hannover, Center for Health Economics Research Hannover (CHERH), Hannover, Deutschland.
authors.forename: J
authors.initials: J
authors.lastname: Zeidler
authors.affiliation: Leibniz Universität Hannover, Center for Health Economics Research Hannover (CHERH), Hannover, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Lange
authors.affiliation: Techniker Krankenkasse, Wissenschaftliches Institut für Nutzen und Effizienz im Gesundheitswesen (WINEG), Hamburg, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Engel
authors.affiliation: Techniker Krankenkasse, Wissenschaftliches Institut für Nutzen und Effizienz im Gesundheitswesen (WINEG), Hamburg, Deutschland.
authors.forename: R
authors.initials: R
authors.lastname: Linder
authors.affiliation: Techniker Krankenkasse, Wissenschaftliches Institut für Nutzen und Effizienz im Gesundheitswesen (WINEG), Hamburg, Deutschland.
authors.forename: F
authors.initials: F
authors.lastname: Verheyen
authors.affiliation: Leibniz Universität Hannover, Center for Health Economics Research Hannover (CHERH), Hannover, Deutschland.
authors.forename: J-M Graf
authors.initials: JG
authors.lastname: von der Schulenburg
authors.affiliation: Medizinische Hochschule Hannover, Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie (HTTG), Hannover, Deutschland.
authors.forename: A
authors.initials: A
authors.lastname: Haverich
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002309:Cardiology / Q000592:standards; D002316:Cardiotonic Agents / Q000592:standards / Q000627:therapeutic use*; D004452:Echocardiography / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D002316:Cardiotonic Agents
keywords: Claims data; Guideline adherence; Heart failure; Mortality; Pharmacotherapy