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

研究成果: 雜誌貢獻文章

5 引文 (Scopus)

摘要

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.

原文英語
頁(從 - 到)750-757
頁數8
期刊Journal of the Chinese Medical Association
80
發行號12
DOIs
出版狀態已發佈 - 十二月 1 2017
對外發佈Yes

指紋

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

ASJC Scopus subject areas

  • Medicine(all)

引用此文

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.

於: Journal of the Chinese Medical Association, 卷 80, 編號 12, 01.12.2017, p. 750-757.

研究成果: 雜誌貢獻文章

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, 卷 80, 編號 12, 頁 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. 於: Journal of the Chinese Medical Association. 2017 ; 卷 80, 編號 12. 頁 750-757.
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title = "Gap between guidelines and clinical practice in heart failure with reduced ejection fraction: Results from TSOC-HFrEF registry",
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.",
keywords = "Adherence, Beta-blocker, Guidelines, Heart failure, Renin-angiotensin blockade, Taiwan",
author = "Chang, {Hung Yu} and Wang, {Chun Chieh} and Jeng Wei and Chang, {Chong Yi} and Chuang, {Yi Cheng} and Huang, {Chien Long} and Eric Chong and Jiunn-Lee Lin and Mar, {Guang Yuan} and Chan, {Kuei Chuan} and Kuo, {Jen Yuan} and Wang, {Ji Hung} and Chen, {Zhih Cherng} and Tseng, {Wei Kung} and Cherng, {Wen Jin} and Yin, {Wei Hsian}",
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TY - JOUR

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

PY - 2017/12/1

Y1 - 2017/12/1

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.

KW - Adherence

KW - Beta-blocker

KW - Guidelines

KW - Heart failure

KW - Renin-angiotensin blockade

KW - Taiwan

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