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 journalArticle

4 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

Fingerprint

Cardiology
Taiwan
Practice Guidelines
Registries
Heart Failure
Guidelines
Mineralocorticoid Receptor Antagonists
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Prescriptions
Physicians
Patient Discharge
Hospitalization
Mortality

Keywords

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

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Gap between guidelines and clinical practice in heart failure with reduced ejection fraction : Results from TSOC-HFrEF registry. / Chang, Hung Yu; Wang, Chun Chieh; Wei, Jeng; Chang, Chong Yi; Chuang, Yi Cheng; Huang, Chien Long; Chong, Eric; Lin, Jiunn-Lee; Mar, Guang Yuan; Chan, Kuei Chuan; Kuo, Jen Yuan; Wang, Ji Hung; Chen, Zhih Cherng; Tseng, Wei Kung; Cherng, Wen Jin; Yin, Wei Hsian.

In: Journal of the Chinese Medical Association, Vol. 80, No. 12, 01.12.2017, p. 750-757.

Research output: Contribution to journalArticle

Chang, HY, Wang, CC, Wei, J, Chang, CY, Chuang, YC, Huang, CL, Chong, E, Lin, J-L, Mar, GY, Chan, KC, Kuo, JY, Wang, JH, Chen, ZC, Tseng, WK, Cherng, WJ & Yin, WH 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, vol. 80, no. 12, pp. 750-757. https://doi.org/10.1016/j.jcma.2017.04.011
Chang, Hung Yu ; Wang, Chun Chieh ; Wei, Jeng ; Chang, Chong Yi ; Chuang, Yi Cheng ; Huang, Chien Long ; Chong, Eric ; Lin, Jiunn-Lee ; Mar, Guang Yuan ; Chan, Kuei Chuan ; Kuo, Jen Yuan ; Wang, Ji Hung ; Chen, Zhih Cherng ; Tseng, Wei Kung ; Cherng, Wen Jin ; Yin, Wei Hsian. / Gap between guidelines and clinical practice in heart failure with reduced ejection fraction : Results from TSOC-HFrEF registry. In: Journal of the Chinese Medical Association. 2017 ; Vol. 80, No. 12. pp. 750-757.
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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.",
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T1 - Gap between guidelines and clinical practice in heart failure with reduced ejection fraction

T2 - Results from TSOC-HFrEF registry

AU - Chang, Hung Yu

AU - Wang, Chun Chieh

AU - Wei, Jeng

AU - Chang, Chong Yi

AU - Chuang, Yi Cheng

AU - Huang, Chien Long

AU - Chong, Eric

AU - Lin, Jiunn-Lee

AU - Mar, Guang Yuan

AU - Chan, Kuei Chuan

AU - Kuo, Jen Yuan

AU - Wang, Ji Hung

AU - Chen, Zhih Cherng

AU - Tseng, Wei Kung

AU - Cherng, Wen Jin

AU - Yin, Wei Hsian

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N2 - 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.

AB - 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.

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KW - Renin-angiotensin blockade

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