title: ESC guidelines adherence is associated with improved survival in patients from the Norwegian Heart Failure Registry.
abstract: OBJECTIVE
  To assess the adherence to heart failure (HF) guidelines for angiotensin-converting enzyme-I (ACE-I), angiotensin II receptor blockers (ARB), and β-blockers and the possible association of ACE-I or ARB, β-blockers, and statins with survival in the large contemporary Norwegian Heart Failure Registry.
  
  
  RESULTS
  The study included 5761 outpatients who were diagnosed with HF of any aetiology (mean left ventricular ejection fraction 32% ± 11%) from January 2000 to January 2010 and followed up until death or February 2010. Adherence to treatment according to the guidelines was high. Cox regression analysis to identify risk factors for all-cause mortality, after adjustment for many factors, showed that ACE-I ≥ 50% of target dose, use of beta-blockers, and statins were significantly related to improved survival (P = 0.003, P < 0.001, and P < 0.001, respectively). Propensity scoring showed the same benefit for these variables.
  
  
  CONCLUSIONS
  Both multivariable and propensity scoring analyses showed survival benefits with β-blockers, statins, and adequate doses of ACE-I in this contemporary HF cohort. This study stresses the importance of guidelines adherence, even in the context of high levels of adherence to guidelines. Moreover, respecting the recommended target doses of ACE-I appears to have a crucial role in survival improvement and, in the multivariate Cox regression analysis, ARB treatment was not significantly associated with a lower all-cause mortality.
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway Centre Hospitalier Universitaire de Québec, Québec, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: De Blois
authors.affiliation: Unit of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Morten Wang
authors.initials: MW
authors.lastname: Fagerland
authors.affiliation: Division Lillehammer, Department of Medicine, Innlandet Hospital Trust, Lillehammer, Norway.
authors.forename: Morten
authors.initials: M
authors.lastname: Grundtvig
authors.affiliation: Preventive Cardio-Rheuma clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Anne Grete
authors.initials: AG
authors.lastname: Semb
authors.affiliation: Faculty of Medicine, University of Oslo, Oslo, Norway Department of Cardiovascular Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Gullestad
authors.affiliation: Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Arne
authors.initials: A
authors.lastname: Westheim
authors.affiliation: Department of Internal Medicine, Ålesund Hosp, Ålesund and Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
authors.forename: Torstein
authors.initials: T
authors.lastname: Hole
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.
authors.forename: Dan
authors.initials: D
authors.lastname: Atar
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway stefan.agewall@medisin.uio.no.
authors.forename: Stefan
authors.initials: S
authors.lastname: Agewall
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D006801:Humans; D015994:Incidence; D008297:Male; D009664:Norway / Q000453:epidemiology; D057216:Propensity Score; D012042:Registries; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate / Q000639:trends; D016277:Ventricular Function, Left / Q000502:physiology
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors
keywords: ACE-I; Beta blockers; Guidelines; Heart failure