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Adherence to guidelines in patients with chronic heart failure in primary health care

Maaike Giezeman1,2, Mats Arne2,3, Kersti Theander2,4

  • 1a School of Medical Sciences , Örebro University , Örebro , Sweden.

Scandinavian Journal of Primary Health Care
|November 7, 2017
PubMed

Insights

Adherence to chronic heart failure (CHF) management guidelines is improving but remains suboptimal, especially regarding medication dosage and patient self-care behaviors. Further improvements in patient education and treatment optimization are needed for better outcomes.

Area of Science:

  • Cardiology
  • Primary Health Care
  • Clinical Practice Guidelines

Background:

  • Chronic heart failure (CHF) management requires adherence to international guidelines for optimal patient outcomes.
  • Primary health care settings play a crucial role in the continuous management of CHF patients.
  • Assessing adherence to current guidelines is essential for identifying areas of improvement in CHF care.

Purpose of the Study:

  • To evaluate the adherence to European Society of Cardiology (ESC) guidelines for CHF diagnostics, pharmacological treatment, and self-care behaviors.
  • To describe the current status of CHF management in primary health care in Sweden.
  • To identify specific areas within guideline adherence that require further attention and intervention.

Main Methods:

  • A cross-sectional descriptive study involving 155 patients diagnosed with CHF.
  • Data collection included medical record review and a postal questionnaire utilizing the European Heart Failure Self-care Behaviour Scale (EHFScBS-9).
  • The study was conducted across three primary health care centers in Sweden.

Main Results:

  • Diagnostic tests like ECG (100%), NT-proBNP (87%), and echocardiography (82%) were frequently performed.
  • Renin-angiotensin system (RAS) inhibitors and beta-blockers (BBs) were prescribed to 78% and 76% of patients, respectively, but often not at target doses (29% and 18%).
  • Combined RAS-inhibitor and BB therapy was given to 59% of patients, with only 9% at target doses. Self-care adherence was suboptimal, particularly in daily weighing and consulting behaviors.

Conclusions:

  • While adherence to CHF guidelines has improved compared to previous studies, it remains suboptimal, particularly concerning medication titration to target doses.
  • Significant room for improvement exists in patient education and the promotion of self-care behaviors in chronic heart failure management.
  • Optimizing pharmacological treatment and enhancing patient self-care strategies are critical for improving CHF management in primary care settings.
Abstract

Keywords:
Guideline adherencechronic heart failurediagnostic assessmentpharmacological treatmentprimary health careself-care behaviour

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