Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC Heart Failure Long-Term Registry

Aldo P. Maggioni, Stefan D. Anker, Ulf Dahlström, Gerasimos Filippatos, Piotr Ponikowski, Faiez Zannad, Offer Amir, Ovidiu Chioncel, Marisa Crespo Leiro, Jaroslaw Drozdz, Andrejs Erglis, Emir Fazlibegovic, Candida Fonseca, Friedrich Fruhwald, Plamen Gatzov, Eva Goncalvesova, Mahmoud Hassanein, Jaromir Hradec, Ausra Kavoliuniene, Mitja LainscakDamien Logeart, Bela Merkely, Marco Metra, Hans Persson, Petar Seferovic, Ahmet Temizhan, Dimitris Tousoulis, Luigi Tavazzi, M. Andarala, E. Fiorucci, E. Folkesson, M. Glemot, G. Gracia, M. Konte, C. Laroche, Pa McNeill, V. Missiamenou, C. Taylor, A. Eberl, S. Heller, T. Dolze, V. Platzer, K. Ablasser, J. Auer, G. Poelzl, D. Moertl, A. Podczeck-Schweighofer, S. Reiter, D. Pravdic, A. Muslibegovic, K. Vitlianova, T. Katova, K. Kotirkov, I. Petrov, T. Velikov, T. Kurteva, D. Kamenova, M. Antova, S. Tisheva, V. Sirakova, J. Krejci, J. Spinar, M. Mikolaskova, J. Krupicka, F. Malek, M. Hegarova, R. Pudil, Z. Monhart, M. Lazarova, A. Reda, T. Khairy, N. Farag, A. Saleh, K. Said, M. Abdel Hamid, S. Halawa, B. Ibrahim, R. Hanna, M. Sobhy, F. El Messiry, A. H. El Shazly, Y. Elrakshy, W. Aboleineen, M. Gouda, A. Youssef, A. Elbahry, A. Abdel, H. Ebeid, G. Nasr, H. Sobhy, M. Ashmawy, C. Lefol, R. Isnard, A. Hagege, S. Thevenin, G. Jondeau, R. Codjia, M. Galinier, F. Bauer, F. Delahaye, N. Lamblin, M. Fertin, P. De Groote, D. Coisne, V. Le Marcis, B. Lequeux, J. F. Ly, P. Lotton, E. Donal, V. Le Moal, A. Basquin, A. Reynaud, C. Ridard, C. Thebault, N. Behar, S. Mascle, F. Schiele, M. F. Seronde, M. Morel, N. Meneveau, P. Luporsi, Y. Bernard, M. Pillot, F. Briand, T. Damy, J. C. Eicher, C. Avgeropoulou, T. Panagiotis, I. Kotrogiannis, C. Stefanadis, C. Chrysohoou, G. Tsitsinakis, T. Dimitroula, A. Karavidas, V. Matzaraki, J. Terrovitis, C. Kapelios, T. Sfakianaki, J. T. Parissis, K. Ntai, A. Papadopoulou, H. Tziourganou, A. Douras, K. Ntertsas, T. Karotsaki, N. Nikoloulis, T. Tsaknakis, A. Patrianakos, E. Nyktari, P. Vardas, P. Soos, N. Nyolczas, A. Csaba Nagy, R. Halmosi, F. Nemeth, G. Amon, J. Dinnyes, A. Vazan Fuhrmann, A. Shotan, I. Alony, J. Elber, A. Olaru, C. Valenti, L. Reggianini, M. G. Modena, S. Copelli, C. Leuzzi, L. Dei Cas, V. Carubelli, C. Lombardi, M. Bulgari, E. Tanghetti, F. Quinzani, R. Rovetta, B. Brasolin, F. Fedele, D. Sergi, F. Romeo, I. Scarfò, M. Vellini, E. Fabris, M. Cinquetti, D. Stolfo, G. Sinagra, M. Merlo, A. Fucili, R. Ferrari, C. Vassanelli, F. Torelli, G. Marchese, L. Zanolla, M. Cicoira, M. Anselmi, C. Piccinino, C. Sartori, M. V. Di Ruocco, P. N. Marino, A. Giordano, S. Brognoli, E. Zanelli, F. Cosmi, C. Cadeddu, S. Bandino, G. Mercuro, M. Deidda, G. Salvemini, M. Correale, M. Di Biase, S. Musio, T. Passero, G. Italiano, P. Agostoni, E. Salvioni, G. Schiavina, A. Squeri, S. Bosi, A. Barbieri, E. Lemme, M. Penco, S. Marcon, S. Romano, M. Di Mauro, A. Frisinghelli, M. Veniani, P. Pieri, S. Novo, A. Proclemer, C. Fresco, D. Miani, J. Artico, F. Gaita, S. Bergerone, S. Pirelli, G. Di Tano, S. Cattaneo, A. Gualco, C. Opasich, S. G. Priori, E. Iori, E. Leci, F. Melandri, N. Voronina, A. Kalnins, E. Rumbinaite, E. Kazakauskaite, I. Petraskiene, R. Karaliute, V. Smalinskas, V. Tamakauskas, D. Petraskiene, R. Brazyte-Ramanauskiene, V. Vysniauskas, A. Nowicka, J. Grabia, R. Dankowski, A. Szyszka, K. Szymanowska, E. Straburzynska-Migaj, M. Kaluzna-Oleksy, S. Grajek, P. Kasztelowicz, T. Orzel, G. Bednarczyk, P. Ruszkowski, J. Klimkiewicz, A. Majzner, A. Matusiak, E. Bylicka, E. Kwiatkowska, K. Kwiatkowska, M. Ochnio, T. Krzyzewska, A. Tarnowska, K. Komuda, M. Sobieszczanska-Malek, P. Leszek, T. Rywik, J. Wisniewska, K. Kozar-Kaminska, M. Piotrowska, T. Zielinski, A. Mamcarz, M. Welnicki, A. Folga, A. Kaplon-Cieslicka, G. Opolski, M. Marchel, P. Balsam, A. Michalek, A. Pawlak, K. Byczkowska, O. Mozenska, K. Gil, R. J. Gil, A. Skrobowski, B. Uzieblo-Zyczkowska, K. Piotrowicz, P. Krzesinski, A. Stanczyk, M. Ciurzynski, P. Bienias, P. Pruszczyk, Z. Juszczyk, P. Switala, S. Stankala, L. Polonski, P. Rozentryt, J. Gabryel, M. Lazorko-Piega, P. Kardaszewicz, I. Poprawa, E. Komorowska, A. Lauko-Rachocka, A. F. Abdulkarim, A. Dudzik-Plocica, A. Zolbach, D. Sajnaga, K. Komorowska, K. Baczynska, M. Samcik, L. Wolniewicz, B. Wozakowska-Kaplon, B. Sosnowska-Pasiarska, R. Bartkowiak, A. Fiega, A. Serwicka, A. Szymczyk, G. Fitas, D. Zysko, A. Poliwczak, M. Broncel, A. Bala, J. D. Kasprzak, L. Jankowski, M. Rudzinska, P. Zycinski, A. Retwinski, I. Pietka, K. Wojtczak Soska, E. Jankowska, A. Cichy, A. Kostka, L. Kaminski, J. Weglarz, A. Bodys, P. Flis, A. Kleinrok, G. Prokop-Lewicka, K. Mosakowska, A. Rynkiewicz, J. Bellwon, A. Dabrowska-Kugacka, E. Lewicka, G. Raczak, E. Skorek, S. Szabowski, W. Krysiak, J. Pietrzak, W. Gilewski, W. Sinkiewicz, A. Furman, J. Zalewski, J. Nessler, K. Bury, A. Grzegorzko, M. Zabojszcz, E. Mirek-Bryniarska, J. Klys, K. Przybylska, M. Szulik, Z. Kalarus, A. Kuczaj, E. Nowalany-Kozielska, A. Krzeminski, A. Ventosa, C. Tavares Aguiar, B. Moura, J. S. Cardoso, I. De Jesus, J. Chin, R. Faria, S. Pereira, G. Lima, T. Oliveira Guimarães, A. R. Francisco, D. Brito, R. Placido, S. Martins, F. Marques, I. Araujo, M. Proenca, R. Cardiga, A. Andrade, A. Castro, A. Pereira, C. Queirós, P. Silva, R. Santos, C. Lourenço, N. Moreno, F. Almeida, I. Quelhas, A. Baptista, A. Ferreira, P. Magalhaes, C. Ferreira, I. Moreira, D. Durao, D. Severino, G. Ferreira Da Silva, L. Marta, M. Peres, C. Stanescu, G. A. Dan, I. Daha, R. Popescu, D. Vinereanu, C. J. Sinescu, C. Macarie, M. Radoi, E. Nechita, R. Christodorescu, M. Datcu, E. Craiu, P. Otasevic, A. D. Ristic, D. Simeunovic, B. Pencic, A. Andric, B. Stojcevski, E. Lebedinski, J. Suzic Lazic, V. Celic, M. Krotin, S. Radovanovic, V. Iric-Cupic, S. Milanov, G. Davidovic, M. Jovic, A. Radin, B. Mihajlovic, J. Stojiljkovic, M. Cankovic, N. Cemerlic Adic, S. Dodic, S. Kecojevic, S. Stojsic, D. Petrovic, M. Deljanin Ilic, S. Ilic, V. Stoickov, S. Antic, D. Stanojevic, M. Pavlovic, V. Atanaskovic, V. Mitic, F. Kovar, J. Murin, M. Pernicky, A. Klabnik, J. Kmec, D. Rajtman, D. Kovac, S. Horvat, B. Krunic, M. Bombek, I. Krajnc, R. Losic, T. Glavic, J. Komel, N. Cernic Suligoj, T. Ravnikar, M. Letonja, V. Cencic, M. Savnik Iskra, M. Strasek, B. Leskovar, B. Drnovsek, J. Klen, A. Marolt, M. Kladnik, C. Slemenik Pusnik, M. Pusnik Vrckovnik, B. Jug, Z. Fras, A. Bartolic, C. Melihen-Bartolic, M. Valentincic, R. Winkler, P. Blanco-Canosa, Z. Grille-Cancela, M. Crespo-Leiro, M. J. Paniagua-Martin, R. Marzoa-Rivas, E. Barge-Caballero, F. Torres Calvo, R. Bravo Marques, F. Epelde Gonzalo, A. Recio Platero, L. De La Fuente Galan, J. Lopez Diaz, L. Renier Goncalvez Ramirez, H. Cubero Gallego, J. F. Sliwiski Herrera, D. Bierge Valero, F. M. Salmeron, J. C. Gallego Page, M. Jose Fernandez, A. Sahuquillo, B. Garcia De La Villa, A. Castro Conde, A. M. Iniesta Manjavacas, O. Salvador Montanes, R. Dalmau Gonzalez-Gallarza, S. Ofelia Rosillo, A. Araujo, A. Briceno, L. Alonso-Pulpon, M. Cobo, T. Soria, M. Gomez-Bueno, P. Garcia-Pavia, A. Gonzalez-Segovia, I. Sayago, J. Segovia Cubero, J. F. Delgado Jiménez, M. Angel Gomez Sanchez, P. Escribano Subias, E. Barrios Garrido-Lestache, M. J. Ruiz Cano, M. Vicente Hernandez, M. Puga-Martinez, E. Lopez-Moreno, J. L. Serrano-Martinez, M. Fernandez-Alvarez, R. Rivera-Lopez, S. Lopez-Fernandez, V. Alcade-Martinez, M. Sanmartin, A. Pellicer-Cabo, D. Garcia-Escriva, F. Ridocci-Soriano, J. Perez-Silvestre, L. Facila-Rubio, P. Garcia-Gonzalez, I. J. Sanchez-Lazaro, L. Almenar-Bonet, J. M. Garcia Pinilla, J. Andres, A. Bayes Genis, E. Roig, S. Mirabet, A. Mendez, L. Garcia-Cosio, A. Garay, G. Muntane, J. Gonzalez-Costello, V. Leon, B. Diaz Molina, I. Famara Hernandez, A. Lara Padron, I. Laynez Cerdena, I. Mateo, J. Quiles, V. Bertomeu, A. Elamrani, J. Angel Rodrigez-Ortega, R. Martinez-Abellan, R. Valero, C. Fernandez-Vivancos, M. Sanz Julve, M. T. Perez-Martinez, D. A. Pascual-Figal, M. D. Martinez Martinez-Espejo, M. Rosario Gracia-Rodenas, F. Pastor-Perez, M. Melin, E. Hägglund, A. Stenberg, I. M. Lindahl, B. Asserlund, L. Olsson, M. Afzelius, P. Karlström, L. Tengvall, P. A. Wiklund, B. Olsson, S. Kalayci, M. Bozkurt, M. Taraktas, Y. Cavusoglu, H. Gunes, M. Birhan Yilmaz, B. Demir, E. Gencer

Research output: Contribution to journalArticle

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Abstract

AimsTo evaluate how recommendations of European guidelines regarding pharmacological and non-pharmacological treatments for heart failure (HF) are adopted in clinical practice.Methods and resultsThe ESC-HF Long-Term Registry is a prospective, observational study conducted in 211 Cardiology Centres of 21 European and Mediterranean countries, members of the European Society of Cardiology (ESC). From May 2011 to April 2013, a total of 12 440 patients were enrolled, 40.5% with acute HF and 59.5% with chronic HF. Intravenous treatments for acute HF were heterogeneously administered, irrespective of guideline recommendations. In chronic HF, with reduced EF, renin-angiotensin system (RAS) blockers, beta-blockers, and mineralocorticoid antagonists (MRAs) were used in 92.2, 92.7, and 67.0% of patients, respectively. When reasons for non-adherence were considered, the real rate of undertreatment accounted for 3.2, 2.3, and 5.4% of the cases, respectively. About 30% of patients received the target dosage of these drugs, but a documented reason for not achieving the target dosage was reported in almost two-thirds of them. The more relevant reasons for non-implantation of a device, when clinically indicated, were related to doctor uncertainties on the indication, patient refusal, or logistical/cost issues.ConclusionThis pan-European registry shows that, while in patients with acute HF, a large heterogeneity of treatments exists, drug treatment of chronic HF can be considered largely adherent to recommendations of current guidelines, when the reasons for non-adherence are taken into account. Observations regarding the real possibility to adhere fully to current guidelines in daily clinical practice should be seriously considered when clinical practice guidelines have to be written.

Original languageEnglish
Pages (from-to)1173-1184
Number of pages12
JournalEuropean journal of heart failure
Volume15
Issue number10
DOIs
Publication statusPublished - Oct 1 2013

Keywords

  • ACE inhibitors
  • Beta-blockers
  • CRT
  • Heart failure
  • ICD
  • MRAs

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Maggioni, A. P., Anker, S. D., Dahlström, U., Filippatos, G., Ponikowski, P., Zannad, F., Amir, O., Chioncel, O., Leiro, M. C., Drozdz, J., Erglis, A., Fazlibegovic, E., Fonseca, C., Fruhwald, F., Gatzov, P., Goncalvesova, E., Hassanein, M., Hradec, J., Kavoliuniene, A., ... Gencer, E. (2013). Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC Heart Failure Long-Term Registry. European journal of heart failure, 15(10), 1173-1184. https://doi.org/10.1093/eurjhf/hft134