Gap between guidelines and clinical practice in heart failure with reduced ejection fraction: Results from TSOC-HFrEF registry

Hung Yu Chang, Chun Chieh Wang, Jeng Wei, Chong Yi Chang, Yi Cheng Chuang, Chien Long Huang, Eric Chong, Jiunn-Lee Lin, Guang Yuan Mar, Kuei Chuan Chan, Jen Yuan Kuo, Ji Hung Wang, Zhih Cherng Chen, Wei Kung Tseng, Wen Jin Cherng, Wei Hsian Yin

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9 Citations (Scopus)

Abstract

Background Heart failure (HF) is a global health problem. Guidelines for the management of HF have been established in Western countries and in Taiwan. However, data from the Taiwan Society of Cardiology-Heart Failure with reduced Ejection Fraction (TSOC-HFrEF) registry showed suboptimal prescription of guideline-recommended medications. We aimed to analyze the reason of non-prescription and clinical outcomes as a result of under-prescription of medications. Methods A total of 1509 patients hospitalized for acute HFrEF were recruited in 21 hospitals in Taiwan by the end of October 2014. Prescribed guideline-recommended medications and other relevant clinical parameters were collected and analyzed at discharge and 1 year after index hospitalization. Results At discharge, 62% of patients were prescribed with either angiotensin-converting enzyme-inhibitors (ACEI) or angiotensin receptor blockers (ARB); 60% were prescribed with beta-blockers and 49% were prescribed with mineralocorticoid receptor antagonists (MRA). The proportions of patients at ≥50% of the target dose for ACEI/ARB, beta-blockers and MRA were 24.4%, 20.6%, 86.2%, respectively. At 1-year follow-up, dosages of ACEI/ARB and MRA were up-titrated in about one-fourth patients, and dosages of beta-blocker were up-titrated in about 40% patients. One-year mortality rate was lowest in patients who received at least 2 classes of guideline-recommended medications with ≥50% of the target dose, and highest in those who received 0 or 1 class of medications. Conclusion The TSOC-HFrEF registry demonstrated the under-prescription of guideline-recommended medications and reluctance of physicians to up-titrate medications to target dose. Action plan needs be formulated in order to improve physician's adherence to HF guidelines.

Original languageEnglish
Pages (from-to)750-757
Number of pages8
JournalJournal of the Chinese Medical Association
Volume80
Issue number12
DOIs
Publication statusPublished - Dec 1 2017
Externally publishedYes

Keywords

  • Adherence
  • Beta-blocker
  • Guidelines
  • Heart failure
  • Renin-angiotensin blockade
  • Taiwan

ASJC Scopus subject areas

  • Medicine(all)

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    Chang, H. Y., Wang, C. C., Wei, J., Chang, C. Y., Chuang, Y. C., Huang, C. L., Chong, E., Lin, J-L., Mar, G. Y., Chan, K. C., Kuo, J. Y., Wang, J. H., Chen, Z. C., Tseng, W. K., Cherng, W. J., & Yin, W. H. (2017). Gap between guidelines and clinical practice in heart failure with reduced ejection fraction: Results from TSOC-HFrEF registry. Journal of the Chinese Medical Association, 80(12), 750-757. https://doi.org/10.1016/j.jcma.2017.04.011