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Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
Implementation of evidence-based therapy in patients with systolic heart failure from 1998-2000
R Reibis1, C Dovifat, R Dissmann
1Klinik am See Ruedersdorf/Berlin, Seebad 84, 15562, Ruedersdorf/Berlin, Germany. rona.reibis@klinikamsee.com
Insights
Guideline-recommended heart failure medication adherence was adequate during inpatient cardiac rehabilitation but decreased significantly in outpatient settings. Further efforts are needed to improve long-term medication management for heart failure patients.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Systolic heart failure incidence is rising globally.
- Guideline-based medication is a cornerstone of heart failure management.
- Optimizing medication adherence is crucial for patient outcomes.
Purpose of the Study:
- To evaluate adherence to guideline-recommended heart failure medications.
- To compare medication adherence during inpatient cardiac rehabilitation versus outpatient follow-up.
- To identify trends in medication prescription rates over time.
Main Methods:
- Prospective registry of 1346 heart failure patients (1998-2000).
- Medication data collected at discharge and during outpatient follow-up (731 +/- 215 days).
- Statistical analysis included Spearman's Rho and exact McNemar test.
Main Results:
- Inpatient guideline adherence was 75.3% at discharge, showing improvement from 1998-2000.
- Outpatient adherence decreased to 68.3% at follow-up (p <0.0001).
- Mortality during the follow-up period was 12.6%.
Conclusions:
- Inpatient guideline adherence for heart failure medication is achievable.
- Significant decline in medication adherence is observed in the outpatient setting.
- Improved strategies are necessary to enhance long-term guideline adherence in heart failure management.
Background:
In recent years, the incidence of systolic heart failure has increased. Besides a complete revascularization, guideline-based medication represents the most effective therapeutic approach.
Aim:
Analysis of adherence of guideline-recommended and actual medication during inpatient cardiac rehabilitation as well as under subsequent outpatient conditions.
Methods:
From 01/1998 to 12/ 2000, 1346 consecutive patients (64 +/- 10 years, 73% male, LVEF 36.3 +/- 8%, 88% ischemic, 6.7% valvular cardiomyopathy, 5.3% other causes, 11.8% atrial fibrillation) were included in a singlecenter prospective register. Medication was recorded at discharge and after the follow-up period of 731 +/- 215 days. Trends in prescription rates were analyzed based on nonparametric correlations (Spearman's-Rho). Changes in medication from in- to outpatient settings were analyzed using exact McNemar test.
Results:
At discharge 75.3% (67.9%/68.9%/ 86.6% in 1998/1999/2000, p <0.001) of the patients were treated as recommended. This rate dropped to 68.3% at followup (p <0.0001). Mortality within the follow-up period was low (12.6%).
Conclusion:
It could be shown that from 1998 to 2000 inpatient guideline conformity was implementable adequately. Outpatient conformity was significantly lower. Although a high proportion of correctly prescribed CHF medication could be demonstrated, a further effort to improve guideline adherence in the management of heart failure patients is desirable.
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