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Differences in guideline-recommended heart failure medication between Dutch heart failure clinics: an analysis of the

G C M Linssen1, J F Veenis2, H P Brunner-La Rocca3

  • 1Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, Almelo, The Netherlands. g.linssen@zgt.nl.

Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
|May 21, 2020
PubMed

Insights

Heart failure medication adherence varied significantly across Dutch clinics, impacting patient outcomes. Guideline-recommended drug prescription rates and dosages differed, highlighting a need for standardized care in heart failure treatment.

Area of Science:

  • Cardiology
  • Clinical Pharmacy
  • Health Services Research

Background:

  • Heart failure (HF) is a condition with significant morbidity and mortality.
  • Guideline adherence in HF management is crucial for optimizing patient prognosis and serves as a quality benchmark.
  • Variations in HF care quality can impact patient outcomes.

Purpose of the Study:

  • To evaluate and compare the utilization of guideline-recommended heart failure (HF) medications across different HF outpatient clinics in the Netherlands.
  • To identify variations in prescription rates and dosages of key HF drugs among Dutch HF clinics.

Main Methods:

  • Cross-sectional analysis of 8,360 patients with heart failure with reduced ejection fraction (HFrEF) from the CHECK-HF registry (2013-2016).
  • Data collected from 34 Dutch outpatient HF clinics.
  • Focused on comparing prescription rates and dosages of medications including beta-blockers, RAS inhibitors, MRAs, ivabradine, and diuretics.

Main Results:

  • Significant variations were observed in the prescription rates of guideline-recommended HF medications, with ranges for beta-blockers (58.9-97.4%), RAS inhibitors (61.9-97.1%), and MRAs (29.9-86.8%).
  • Prescribed dosages also differed significantly, with target dose achievement rates varying widely for beta-blockers (5.9-29.1%), RAS inhibitors (18.4-56.1%), and MRAs (13.2-60.6%).
  • These disparities in medication use and dosing were not fully attributable to differences in patient characteristics.

Conclusions:

  • Substantial inter-clinic variability exists in the prescription rates and dosages of guideline-recommended medications for HFrEF patients in the Netherlands.
  • The observed differences suggest potential quality-of-care variations in HF management across outpatient clinics.
  • Further investigation is warranted to understand the drivers of these variations and to promote standardized, evidence-based HF care.
Abstract

Keywords:
AdherenceGuidelinesHFmrEFHFrEFHeart failureMedication

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