Physicians' adherence to guideline-recommended medications in heart failure with reduced ejection fraction: data from the QUALIFY global survey.
To assess physicians' adherence to guideline-recommended medications for the treatment of chronic heart failure (CHF) with reduced ejection fraction.



QUALIFY is an international prospective observational longitudinal survey of 7092 CHF outpatients recruited 1-15 months after hospitalization for heart failure from September 2013 to December 2014 in 547 centres in 36 countries. We constructed a five-class guideline adherence score for angiotensin converting enzyme inhibitors (ACEIs), beta-blockers, angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists, and ivabradine. The adherence score was good in 67%, moderate in 25%, and poor in 8% of patients. Adherence was lower in women than men but there were differences in age (65.7 ± 12.5 years women vs. 62.2 ± 12.4 years men, P < 0.001) and the proportion of women at ≥50% target dose of beta-blockers was lower in those >67 years (median) (11% vs. 16.2%, P = 0.005). Geographic variations were observed with lower adherence scores in Central/Eastern European countries. The proportion of patients at target dose and ≥50% of target dose was low (27.9% and 63.3% for ACEIs, 14.8% and 51.8% for beta-blockers, 6.9% and 39.5% for ARBs, and 6.9% and 39.5% for ivabradine, respectively). It was also lower in patients most recently hospitalized (<6  vs. ≥6 months) except for beta-blockers.



This international survey shows that adherence to guideline-recommended medications is relatively satisfactory but the dosage of recommended CHF medications is usually suboptimal. Action plans aimed at improving adherence to guidelines are required.
Institute of Cardiometabolism and Nutrition (ICAN), Pierre & Marie Curie Paris VI University, La Pitié-Salpétrière Hospital, AP-HP, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
Michel
M
Komajda
Innovative Clinical Trials, Department of Cardiology & Pneumology, University Medical Centre Göttingen (UMG), Göttingen, Germany.
Stefan D
SD
Anker
Imperial College London, Royal Brompton Hospital, London, UK.
Martin R
MR
Cowie
Athens University Hospital Attikon, Athens, Greece.
Gerasimos S
GS
Filippatos
Department of Biometry, Lincoln, Boulogne-Billancourt, France.
Bastian
B
Mengelle
Medical University, Faculty of Public Health, Wroclaw, Poland.
Piotr
P
Ponikowski
Maria Cecilia Hospital, GVM Care & Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy.
Luigi
L
Tavazzi
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001208:Asia; D001315:Australia; D001552:Benzazepines / Q000627:therapeutic use*; D002170:Canada; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D005060:Europe; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D000077550:Ivabradine; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D013318:Stroke Volume; D011795:Surveys and Questionnaires
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D001552:Benzazepines; D002317:Cardiovascular Agents; D000451:Mineralocorticoid Receptor Antagonists; D000077550:Ivabradine
Adherence; Chronic heart failure; Guidelines; Observational studies; Pharmacological treatment