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

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Abstract

Background: The effectiveness of chronic heart failure (CHF) pharmacotherapy in unselected cohorts is unknown. Aims: To estimate the association between quality of CHF pharmacotherapy and all-cause mortality risk. 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). 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. © 2008.

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Störk, S., Hense, H. W., Zentgraf, C., Uebelacker, I., Jahns, R., Ertl, G., & Angermann, C. E. (2008). 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. European Journal of Heart Failure, 10(12), 1236–1245. https://doi.org/10.1016/j.ejheart.2008.09.008

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