Real-world implementation of guidelines for heart failure management: A systematic review and meta-analysis

Tsigkas, Grigorios; Apostolos, Anastasios; Aznaouridis, Konstantinos; Despotopoulos, Stefanos; Chrysochoou, Christina; Naka, Katerina K.; Davlouros, Periklis

doi:10.1016/j.hjc.2022.04.006

Cited by 13 publications

(9 citation statements)

References 28 publications

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“…[24] The recent large systematic review and meta-analysis on physicians' adherence to HF guidelines reported a 80.9% prescription rate for ACEI/ARBs, 78.0% for B-blockers, and 47.4% for MRAs. [26] Two studies conducted in Nigeria and Ethiopia found prescription rates of 83% and 79.8%, 48% and 79.4%, and 41% and 49%, for ACEI/ARBs, B-blockers, and MRAs, respectively. [28], [29] Justification of the study Since physicians' guideline adherence has been shown to reduce HFrEF mortality and hospitalization, societal guidelines recommend assessing the adherence as a major quality indicator of HFrEF care.…”

Section: Physicians' Guideline Adherencementioning

confidence: 99%

“…[25], [27] Uptitration to more than 50% of the target dose is also essential as it has been shown to decrease mortality in HF patients. [26] The QUALIFY registry includes 19 and 15 centers in two African countries, Egypt and Morocco respectively. This survey found satisfactory and comparable guideline adherence scores in all geographic regions except for central and eastern Europe which had significantly lower scores.…”

Section: Physicians' Guideline Adherencementioning

confidence: 99%

“…[25], [27] Uptitration to more than 50% of the target dose is also essential as it has been shown to decrease mortality in HF patients. [26]…”

Section: Introductionmentioning

confidence: 99%

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Physicians’ Adherence to Guidelines on Medical Therapy for Heart Failure and Patients’ Outcomes in a Kenyan Referral Hospital

Mucyo,

Shah,

Mohamed

et al. 2023

Preprint

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BackgroundAdherence to guidelines on prescription and uptitration of GDMT for HFrEF is associated with reduced mortality and hospitalization. Published data on physicians’ GDMT prescription in sub-Saharan Africa is scarce. In addition, there is a need for data on patients’ characteristics, treatment, and outcomes in this region.ObjectiveTo determine physicians’ level of adherence to guidelines on prescription and uptitration of medical therapy for HFrEF at AKUHN, a referral hospital in Nairobi, Kenya.MethodsWe reviewed 280 files of all HFrEF patients admitted over a 3-year period. Detailed patients’ characteristics and outcomes were analyzed. We calculated the Guideline Adherence Index (GAI) and the QUality of Adherence to guideline recommendations for LIFe-saving treatment in heart failure (QUALIFY) scores. From worst to best, GAI ranges from 0 to 100%, while QUALIFY scores were categorized as poor, moderate, or good.ResultsThe median age (IQR) was 63 years (53,74); 165(58.9%) were male; and 207(74.2%) were black; 98(35%) had ischemic heart disease; 153(54.6%) had hypertension, and 101(36.1%) had diabetes. At six months follow-up, 43.8% of patients had been readmitted at least once and 8.8% had died. GAI at discharge were 66.2%, 71.7%, and 42.6% for ACEI/ARNI/ARBs, B-blockers, and MRAs, respectively. At 6 months, the scores were 86.3%, 84.4%, and 61.2%, respectively. GAI for SGLT2is was 38.9% at 6 months. The proportions for good QUALIFY scores for ACEI/ARNI/ARBs, B- blockers, and MRAs were 35.8%, 38.5%, and 9.5%, respectively. Uptitration to ≥ 50% of target dose was done in 51.9%, 48.7%, and 7.9% of patients for ACEI/ARNI/ARBs, B- blockers, and MRAs, respectively.ConclusionPhysicians’ level of adherence to prescription and up-titration of GDMT was satisfactory for ACEI/ARNI/ARBs and B-blockers, however, it was poor for SGLT2is and MRAs. There is a need for regular surveys on prescription and uptitration of GDMT with a special attention to MRAs and SGLT2is.

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Section: Physicians' Guideline Adherencementioning

confidence: 99%

Section: Physicians' Guideline Adherencementioning

confidence: 99%

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Physicians’ Adherence to Guidelines on Medical Therapy for Heart Failure and Patients’ Outcomes in a Kenyan Referral Hospital

Mucyo,

Shah,

Mohamed

et al. 2023

Preprint

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“…In both inpatient and outpatient settings, the optimization of treatment appears slow, irregular, unequal, and incomplete. Shockingly, the utilization of GDMT in routine clinical practice remains remarkably low, with discontinuation rate of mineralocorticoid receptor antagonists (MRA) reaching as high as 42% [4][5] . In the Heart Failure Drug Treatment-Inertia, Titration, and Discontinuation: A Multinational Observational Study (EVOLUTION HF), encompassing patients initiating any GDMT within 12 months of post-hospitalization for HF, the initiation of novel GDMT is often delayed, with few patients receiving target doses necessitating uptitration among the 266,589 patients [6] .…”

Section: Enhancing Implementation Of Evidence-based Heart Failure The...mentioning

confidence: 99%

Enhancing implementation of evidence-based heart failure therapies in clinical practice: vital to modern medicine

Fu,

Swedberg

2024

Cardiology Plus

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“…Based on 11 studies (since January 2010) including 45,866 patients, MRA use was 47% (95% Cl 42–53) whilst ACEi/ARB and BB use was 81% (95% CI 74–86) and 78% (95% CI 70–84), respectively. 16 …”

Section: Reviewmentioning

confidence: 99%

Emerging concepts in heart failure management and treatment: focus on current guideline-directed medical therapy for heart failure with reduced ejection fraction

González¹,

Mejía²,

Kaplinsky³

et al. 2023

DIC

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One of the most relevant and differentiating aspects provided by the 2021 European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure is the retraction of the historical stepped and vertical pharmacological treatment scheme for heart failure with reduced ejection fraction (HFrEF). Subsequently, it was replaced by an updated algorithm that places four therapeutic families in the same initial horizontal step with an equally high degree of recommendation (class I). In this context, these four pillars, which have demonstrated a significant reduction in mortality and hospitalizations in patients with HFrEF, include (1) angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB)/angiotensin II receptor-neprilysin inhibitors (ARNi), (2) beta blockers, (3) mineralocorticoid receptor antagonists (MRA) and (4) sodium–glucose cotransporter 2 inhibitors (SGLT2is) as the main novelty. This manuscript reviews the current therapeutic algorithm with a special focus on the therapeutic value of adding an MRA (still underused in both clinical trials and real world), changing an ACEi/ARB for an ARNi and incorporating an SGLT2i in patients with HFrEF. This article is part of the Emerging concepts in heart failure management and treatment Special Issue: https://www.drugsincontext.com/special_issues/emerging-concepts-in-heart-failure-management-and-treatment

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Real-world implementation of guidelines for heart failure management: A systematic review and meta-analysis

Cited by 13 publications

References 28 publications

Physicians’ Adherence to Guidelines on Medical Therapy for Heart Failure and Patients’ Outcomes in a Kenyan Referral Hospital

Physicians’ Adherence to Guidelines on Medical Therapy for Heart Failure and Patients’ Outcomes in a Kenyan Referral Hospital

Enhancing implementation of evidence-based heart failure therapies in clinical practice: vital to modern medicine

Emerging concepts in heart failure management and treatment: focus on current guideline-directed medical therapy for heart failure with reduced ejection fraction

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