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

Research output: Contribution to journalArticlepeer-review

14 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 2017
Externally publishedYes

Keywords

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

ASJC Scopus subject areas

  • Medicine(all)

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