Adherence to guideline-directed medical and device Therapy in outpAtients with heart failure with reduced ejection fraction: The ATA study.

Autor: Kocabaş U; Department of Cardiology, Başkent University Istanbul Hospital, Istanbul, Turkey., Kıvrak T; Department of Cardiology, Firat University, School of Medicine Hospital, Elazığ, Turkey., Yılmaz Öztekin GM; Department of Cardiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey., Tanık VO; Department of Cardiology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey., Özdemir IH; Department of Cardiology, Nizip State Hospital, Gaziantep, Turkey., Kaya E; Department of Cardiology, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey., Yüce EI; Department of Cardiology, Kelkit State Hospital, Gümüşhane, Turkey., Avcı Demir F; Department of Cardiology, Elmalı State Hospital, Antalya, Turkey., Doğduş M; Department of Cardiology, Karaman State Hospital, Karaman, Turkey., Altınsoy M; Department of Cardiology, University of Health Sciences Ankara Atatürk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey., Üstündağ S; Department of Cardiology, Erzincan Binali Yıldırım University, Mengücek Gazi Educatıon and Research Hospital, Erzincan, Turkey., Özyurtlu F; Department of Cardiology, Grandmedical Hospital, Manisa, Turkey., Karagöz U; Department of Cardiology, Izmir Katip Celebi University Atatürk Education and Research Hospital, Izmir, Turkey., Karakuş A; Department of Cardiology, Besni State Hospital, Adıyaman, Turkey., Urgun ÖD; Department of Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey., Sinan ÜY; Department of Cardiology, Faculty of Medicine, Istanbul University, Institute of Cardiology, Istanbul,Turkey., Mutlu I; Department of Cardiology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey., Şen T; Department of Cardiology, Kütahya Health Sciences University, School of Medicine, Kütahya, Turkey., Astarcıoğlu MA; Department of Cardiology, Kütahya Health Sciences University, School of Medicine, Kütahya, Turkey., Kınık M; Department of Cardiology, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey., Tok ÖÖ; Department of Cardiology, Memorial Hospital, Istanbul, Turkey., Uygur B; Department of Cardiology, University Of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey., Yeni M; Department of Cardiology, Isparta State Hospital, Isparta, Turkey., Alan B; Department of Cardiology, Okan University, School of Medicine, Istanbul, Turkey., Dalgıç O; Department of Cardiology, Life Park Hospital, Sivas, Turkey., Sarıtürk Ç; Department of Biostatistics, Başkent University Adana Hospital, Adana, Turkey., Altay H; Department of Cardiology, Başkent University Istanbul Hospital, Istanbul, Turkey., Pehlivanoğlu S; Department of Cardiology, Başkent University Istanbul Hospital, Istanbul, Turkey.
Jazyk: angličtina
Zdroj: Anatolian journal of cardiology [Anatol J Cardiol] 2020 Jul; Vol. 24 (1), pp. 32-40.
DOI: 10.14744/AnatolJCardiol.2020.91771
Abstrakt: Objective: Despite recommendations from heart failure guidelines on the use of pharmacologic and device therapy in patients with heart failure with reduced ejection fraction (HFrEF), important inconsistencies in guideline adherence persist in practice. The aim of this study was to assess adherence to guideline-directed medical and device therapy for the treatment of patients with chronic HFrEF (left ventricular ejection fraction ≤40%).
Methods: The Adherence to guideline-directed medical and device Therapy in outpAtients with HFrEF (ATA) study is a prospective, multicenter, observational study conducted in 24 centers from January 2019 to June 2019.
Results: The study included 1462 outpatients (male: 70.1%, mean age: 67±11 years, mean LVEF: 30%±6%) with chronic HFrEF. Renin-angiotensin system (RAS) inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRAs), and ivabradin were used in 78.2%, 90.2%, 55.4%, and 12.1% of patients, respectively. The proportion of patients receiving target doses of medical treatments was 24.6% for RAS inhibitors, 9.9% for beta-blockers, and 10.5% for MRAs. Among patients who met the criteria for implantable cardioverter-defibrillator (ICD) and cardiac resynchronization therapy (CRT), only 16.9% of patients received an ICD (167 of 983) and 34% (95 of 279) of patients underwent CRT (95 of 279).
Conclusion: The ATA study shows that most HFrEF outpatients receive RAS inhibitors and beta-blockers but not MRAs or ivabradin when the medical reasons for nonuse, such as drug intolerance or contraindications, are taken into account. In addition, most eligible patients with HFrEF do not receive target doses of pharmacological treatments or guideline-recommended device therapy.
Databáze: MEDLINE
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