1. Physicians' guideline adherence is associated with long-term heart failure mortality in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry
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Komajda, M. Schöpe, J. Wagenpfeil, S. Tavazzi, L. Böhm, M. Ponikowski, P. Anker, S.D. Filippatos, G.S. Cowie, M.R. Aleksanyan, A. Atayan, L. Avetisyan, A. Davtyan, N. Drambyan, M. Gevorgyan, K. Grigoryan, M. Hakobyan, Z. Hayrapetyan, H. Kocharyan, L. Kramarevskaya, T. Melqonyan, A. Muradyan, F. Nanyan, R. Ordyan, A. Ordyan, M. Piruzyan, A. Podosyan, G. Safaryan, K. Sargsyan, T. Sarkisyan, A. Sisakyan, H. Ter-Grigoryan, V. Ustyan, T. Alexopoulos, C. Amerena, J. Arstall, M. Ayres, B. Barron, G. Beltrame, J. Bou-Samra, J. Brown, M. Cross, D. Dwyer, N. Eccleston, N. Hare, D. Ho, B. Hopper, I. Jackson, B. Korczyk, D. Lattimore, J.D. Levendel, A. Macfadyen, R. Pandeli, V. Playford, D. Richardson, M. Senior, J.A. Shah, A. Shetty, P. Soward, A. Srivastava, P. Swale, M. Vogl, E. Wai, B. William, M. Worthington, A. Wright, S. Brunner, B. Fuhrmann, W. Horer, L. Maca, T. Nahler, A. Ortner, H. Racz, G. Scheibner, P. Sebald, C. Abdullayev, A. Abdullayev, R. Ahmadov, A. Alakbarov, E. Aliyev, F. Aliyev, F. Bakhshaliyev, A. Bakhshiyev, M. Dadashova, G. Dashdamirov, R. Faradjova, N. Guliyev, A. Guliyev, F. Guliyeva, S. Hajiyev, G. Ibrahimov, F. Imanov, G. Isayeva, A. Isayeva, M. Jabrailova, U. Jafarov, R. Jahangirov, T. Khalilov, A. Khalilov, S. Mehdiyev, S. Najafov, R. Samedova, H. Shahhuseynov, S. Yusifly, R. Yusifov, T. Zahidova, K. Zeynalov, A. Abdullatif, A. Al-Banna, R. Haiky, W. Husain, A. Jamsheer, A. Barbuk, O. Belskaya, M. Borodko, V. Kurlianskaya, A. Mackevich, S. Mankevich, N. Moroz-Vodolazhskaya, N. Ravtovich, O. Saevich, A. Troyanova, T. Chughtai, A. Johar, S. Luqman, N. Nair, T.C.-R. Deyoung, P. Ezekowitz, J. Frenette, M. Howlett, J. Huynh, T. Nguyen, V. Toma, M. Orenstein, T. Rinne, M.R.C. Virani, S. Zieroth, S. Ailiman, M. Cong, H. Ding, W. Dong, W. Dong, Y. Gao, C. Li, L. Li, Z. Liang, Y. Liu, X. Liu, S. Luo, S. Shi, H. Tian, Q. Wang, D. Wang, J. Wei, M. Wu, C. Xu, D. Yang, X. Yang, Z. Zhang, C. Zhang, Q. Zhang, Y. Zhang, R. Zheng, Y. Zhao, L. Zhou, J. Buch, P. Davidsen, F. Eiskjær, H. Bruun, N.E. Kragh-Thomsen, N.E. Franow, H. Køber, L. Korup, E. Madsen, B.K. Mikkelsen, K. Nielsen, K.A. Nørgaard, A. Refsgaard, J. Rickers, H. Kaiser, P. Sykulski, R. Zeuthen, E.L. El Fottoh, A.A. El Badry, M. El Hady, Y.A. El Kady, E. El Khatib, H. Fawzy, M. Hegazy, H. Salama, M.K. Mortada, A. Mostafa, T. Mwafy, A. Ossama, M. Samir, S. Seleem, M. Sobhy, B. Bregadze, G. Chelidze, K. Chumburidze, V. Jalabadze, K. Khabeishvili, G. Kiphiani, Z. Klimiashvili, Z. Kvitsiani, A. Mamatsashvili, M. Melia, I.M.A. Oragvelidze, T. Orjonikidze, S. Paposhvili, K. Petriashvili, S. Phaghava, Z. Shushania, M. Tsetskhladze, E. Tsinamdzgvishvili, B. Abdel-Qader, M. Al-Zoebi, A. Böhm, G. Bosch, R. Brune, S. Bunge, K. Dominick, K. Duda, S. Erdogan, A.E. Faber, G. Fach, C. Fechtrup, C. Frickel, S. Giokoglu, K. Haas, J. Hagenow, A. Haj-Yehia, A. Hansen, C. Hartung, W.M. Hauser, E.R. Hofmeister, A. Hohensee, H. Hüttemann, M. Keim, M. Krämer, A. Langwasser, K. Lodde, B.P. Lorch, G. Lüer, C. Müller, K. Placke, J. Plesch, B. Potolidis, L. Richter, F. Rieker, W.A. Schlichting, J. Stenzel, G. Theuer, J.D. Marcin, A. Warkentin, R. Wegner, M. Wilke, A. Agrafiotis, I. Aleksandridis, I. Farmakis, D. Giannakoulas, G. Karavidas, A. Lamprou, A. Ninios, V. Panagiotopoulos, K. Papadopoulos, K. Siachos, S. Dékány, M. Borbéy, A. Borsányi, T. Forster, T. Gavallér, H. Gyuricza, I. Heltai, K. Herczeg, B. HŐgye, M. Losonczi, I. Merkely, B. Metz, E. Muk, B. Nagy, K. Ökrös, M. Piry, K. Poós, G. Sárszegi, Z. Somogyi, T. Sziliczei-Németh, E. Tátrai, T. Zima, E. Zsigmond, A. Daly, C. Mahon, N. Meany, B. Abbdi, I. Awaysheh, R. Azouka, M. Hamoudeh, S. Nammas, A. Okkeh, O. Aimakova, G. Ismagulova, Z. Issabekova, A. Junusbekova, G.A. Koshumbayeva, K. Madaliyev, K. Mekebekova, D. Mukatova, A. Ospanova, G. Sadvakassova, G. Sunkarbekova, Z. Yegorova, Y. Zhangelova, S. Kim, K.H. Al-Mutairi, M. Gaber, Y. Ghali, I. Ghanem, A. Hafez, H. Haiba, M. Koushy, T. Mahmoud, A. Raafat, G. Sallam, M. Senousi, O. Soliman, M. Massih, T.A. Ali, S.A. Jaoude, S.A. Azzi, N. Badaoui, G. Bayeh, H. Beydoun, A. Chammas, E. Dib, H. Gebran, M. Ghanem, G. Haidar, H. Hamadeh, M. Hamoui, O. Hobeika, R. Jazra, C. Kabbani, S. Kadri, Z. Karanaminassian, R. Kassab, R. Kleit, M. Mansour, H. Mousallem, N. Semaan, C. Simonian, A. Sarkis, A. Succar, S. Zalloum, R. Zind, R. Anusauskiene, J. Grigaliuniene, A. Karaliute, R. Kavoliuniene, A. Kozlovaite, V. Miliuniene, D. Rinkuniene, D. Rudys, A. Stasaityte, D. Aziz, F.A.A. Rahim, A.A.A. Ahmad, R. Ahmadsah, S.H.K.A. Ang, C.C. Ang, S.H. Cham, Y.L. Chee, K.H. Chooi, K.C. Chu, C.M. Fam, T.L. Fong, A. Ismail, O. Ismail, J.R. Kamarulzaman, M.H. Kasim, S.S. Khiew, N.Z. Krishnan, C. Krishinan, S. Lau, G. Lee, L.Y. Liew, H.B. Lim, C.W. Mahendran, K. Dass, R.D.M. Mohamad, R. Arshad, M.K.M. Unit, H.M. Mustapha, Z. Ng, W.K. Ong, T.K. Oon, Y.Y. Ramli, A.W. Ramanathan, G.R.L. Ross, N.T. Said, A. Sarwar, M. Tan, E. Tan, S.K. Voon, C.Y. Yusoff, M.R. Abidin, H.A.Z. Chua, S.K. Yew, K.L. Amin, N.H.M. Kandiah, K. Chong, L.A. Mohamed, M.S. Lim, B.K. Koh, K.T. Low, D.W. Abdelkhirane, C. Allali, Y. Askour, M. Balafrej, K. Bendagha, N. Bendriss, L. Benjelloun, H. Chaib, A. Cherradi, G. Cherti, M. Chtioui, M. El Belghiti, A.R. Fihri, O.F. Habbal, R. El Hattaoui, M. Khatouri, A. Kheyi, J. Kriem, J. Soufiane, N. Soufiani, A. Zaimi, S. Adamczyk-Kot, D. Barg, Z. Bartkowiak, R. Braciszewicz, W. Czajkowska, E. Dudek-Niechciał, M. Grzelakowski, P. Jarosik, Z. Jerzykowska, O. Koprowski, P. Krysiak, W. Łajkowski, Z. Ziemlewska-Krawczyk, E. Lelonek, M. Lewicka, E. Płonka, J. Sadowski, J. StĘpieŃ-Adamczewska, V. Szponar, J. WrzesiŃski, K. Brito, D.A. Araújo, I. Figueiredo, J.P.A. Campelo, M.B. Sardinha, P.M.B. Fernando, P. de Brito Domingues Sanches Peres de Noronha, M.A. Baptista, S.B.C. Cardoso Pinto, J.P. Piçarra, B.M.C. Farto e Abreu, P. da Fonseca, M.C.F.G. Soares, A.I.C.G.O. Resende, J.D.A. Durão, D.L. Nascimento, A.I.F.V. Bernardes, E.L.M.O. Marques, F. Ramos, M.A.N. Sargento, L.J.M. dos Santos, J.P.F. Raimundo, A. da Luz Ventosa, A.M.S. Sarmento, P. Aguiar, C.M.T. Ahmed, E. Al-Suwaidi, J. Al Dabdoob, W. Badr, A. Gomaa, M. Albu, M. Antohi, I. Apavaloaei, C. Ardelean, A. Badea, G. Bicescu, G. Blaj, C. Bogdan, L. Bucatanschi, M. Buzea, A. Calarasu, V. Catinean, S. Christodorescu, R. Cocoi, D. Costache, L. Cretu, D. Crisu, D. Dima-Cozma, C. Dumitrescu, S. Enache, V. Firastrau, V. Frigy, A. Gherghina, A. Girbea, S. Gutu, A. Horovitz, M. Hortopan, G. Istratoaie, O. Jianu, C. Jinga, L. Lighezan, D. Luka, A. Magheru, S. Mercea, D. Miklos, K. Moga, R. Oprea, N. Paraschiv, D.M. Pop, D. Rusu, R. Sirbu, I. Socoteanu, E. Stanciulescu, G. Suteu, A. Tetiu, O. Traistaru, A. Tudoran, M. Turiceanu, M.C. Viinkler, L. Adonina, E. Akinina, S. Alferov, P. Arkhipov, M. Aroutunov, G. Babkin, A. Barbashina, T. Bochkareva, J. Boldueva, S. Bukhonkina, J. Chumakova, S.G. Fayans, I. Furmenko, G. Galyavich, A. Grinstein, Y. Klein, G. Kastanayan, A. Kazachkova, T. Korolev, S. Koshelskaya, O. Kosmacheva, E. Koziolova, N. Kuimov, A. Kushnarenko, N. Lebedev, P. Matushin, G. Mineeva, E. Motylev, I. Nedbaykin, A. Nevzorova, V. Rachkova, S. Rebrov, A. Reznik, I. Saiganov, S. Sayfutdinov, R. Schekotov, V. Serdechnaya, E. Shalaev, S. Shtegman, O. Sitnikova, M. Smolenskaya, O. Sulimov, V. Tarlovskaya, E. Temnikova, E. Timonin, D. Tolstov, S. Uskatch, T. Ustyuzhanin, V. Valeeva, R. Vasyuk, Y. Viktorova, I. Yakushin, S. Zadionchenko, V. Zateischikov, D. Zhirov, I. Bollová, D. Dulková, K. Fazekaš, F. Hermel, I. KŇazeje, M. NedĚĽová, I. Nociar, J. Procházka, L. Pundová, L. Slanina, M. Varga, I. Almenar, L. Beltrán, P. Cobo, M. Delgado, J. Enjuanes, C. Garrido, I. Gómez, M.A. Manito, N. Marzal, D. Murga, N. Ocampo, M. Pérez, J. Sánchez, I. Buakhamsri, A. Leemasawat, K. Kanoksilp, A. Kiatchoosakun, S. Phrommintikul, A. Porapakkham, P. Rodprasert, S. Senthong, V. Wongcharoen, W. Wongwantanee, S. Bahadir, H. Emül, A. Gokce, M. Gurcagan, A. Kaya, O.K. Keser, A. Pinar, P. Taș, M.H. Tosun, H.B. Yazlar, A.S. Yilmaz, S. Yuksel, Y. Bagriy, A. Ivchyna, N. Lyashenko, A. Matviychuk, N. Shchukina, O. Tkach, N. Tseluyko, V. Vasylieva, L. Abdallah, A. Agrawal, A. Basleeb, F. Bazargani, N. Hatou, E. Al Kaddour, A.R. Al Kasser, M. Al Mulla, A. Radaideh, G. Salustri, A. on behalf of the QUALIFY Investigators
- Abstract
Background: Physicians' adherence to guideline-recommended therapy is associated with short-term clinical outcomes in heart failure (HF) with reduced ejection fraction (HFrEF). However, its impact on longer-term outcomes is poorly documented. Here, we present results from the 18-month follow-up of the QUALIFY registry. Methods and results: Data at 18 months were available for 6118 ambulatory HFrEF patients from this international prospective observational survey. Adherence was measured as a continuous variable, ranging from 0 to 1, and was assessed for five classes of recommended HF medications and dosages. Most deaths were cardiovascular (CV) (228/394) and HF-related (191/394) and the same was true for unplanned hospitalizations (1175 CV and 861 HF-related hospitalizations, out of a total of 1541). According to univariable analysis, CV and HF deaths were significantly associated with physician adherence to guidelines. In multivariable analysis, HF death was associated with adherence level [subdistribution hazard ratio (SHR) 0.93, 95% confidence interval (CI) 0.87–0.99 per 0.1 unit adherence level increase; P = 0.034] as was composite of HF hospitalization or CV death (SHR 0.97, 95% CI 0.94–0.99 per 0.1 unit adherence level increase; P = 0.043), whereas unplanned all-cause, CV or HF hospitalizations were not (all-cause: SHR 0.99, 95% CI 0.9–1.02; CV: SHR 0.98, 95% CI 0.96–1.01; and HF: SHR 0.99, 95% CI 0.96–1.02 per 0.1 unit change in adherence score; P = 0.52, P = 0.2, and P = 0.4, respectively). Conclusion: These results suggest that physicians' adherence to guideline-recommended HF therapies is associated with improved outcomes in HFrEF. Practical strategies should be established to improve physicians' adherence to guidelines. © 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology
- Published
- 2019