Back to Search
Start Over
Pharmacotherapy according to treatment guidelines is associated with lower mortality in a community-based sample of patients with chronic heart failure: a prospective cohort study.
- Source :
-
European journal of heart failure [Eur J Heart Fail] 2008 Dec; Vol. 10 (12), pp. 1236-45. Date of Electronic Publication: 2008 Nov 08. - Publication Year :
- 2008
-
Abstract
- Background: The effectiveness of chronic heart failure (CHF) pharmacotherapy in unselected cohorts is unknown.<br />Aims: To estimate the association between quality of CHF pharmacotherapy and all-cause mortality risk.<br />Methods and Results: In a prospective cohort study, 1054 unselected patients with CHF (61% with reduced and 39% with normal left ventricular ejection fraction (LVEF)) were consecutively enrolled. Quality of pharmacotherapy was assessed by calculating a guideline adherence indicator (GAI-3, range 0-100%) based on prescription of beta blockers, angiotensin converting enzyme inhibitors or angiotensin receptor II type-1 blockers, and mineralocorticoid receptor antagonists. Median follow-up in survivors was 595 days (100% complete). In patients with reduced LVEF the median GAI-3 was 67%, and inversely associated with age, CHF severity, and important comorbidities. Mortality rates in GAI-3 categories low/medium/high were 79/30/11 per 100 person-years. In multivariable Cox regression, high GAI-3 was independently predictive of lower mortality risk: hazard ratio (HR) 0.50 (95% confidence interval [CI] 0.32-0.74; P<0.001) vs low GAI-3. This association was also observed in subgroups of high age (HR 0.42, 95%CI 0.27-0.66; P<0.001) and women (HR 0.42, 95%CI 0.23-0.79; P=0.007).<br />Conclusions: In this community-based cohort with CHF, better implementation of pharmacotherapy was associated with better prognosis in patients with reduced LVEF, irrespective of age and sex.
- Subjects :
- Adrenergic beta-Antagonists therapeutic use
Aged
Angiotensin II Type 1 Receptor Blockers therapeutic use
Angiotensin-Converting Enzyme Inhibitors therapeutic use
Chronic Disease
Cohort Studies
Confidence Intervals
Female
Guideline Adherence
Heart Failure mortality
Humans
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Practice Guidelines as Topic
Prognosis
Prospective Studies
Risk Factors
Stroke Volume drug effects
Survival Analysis
Ventricular Function, Left drug effects
Cardiovascular Agents therapeutic use
Heart Failure drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1388-9842
- Volume :
- 10
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- European journal of heart failure
- Publication Type :
- Academic Journal
- Accession number :
- 18996739
- Full Text :
- https://doi.org/10.1016/j.ejheart.2008.09.008