© 2008 European Society of Cardiology
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
a Department of Internal Medicine I/Center for Cardiovascular Medicine, University of Würzburg Klinikstrasse 6-8, D-97070 Würzburg, Germany
b Institute of Epidemiology and Social Medicine, University of Münster Domagkstr. 3, D-48129 Münster, Germany
* Corresponding author. University of Würzburg, Department of Internal Medicine I/Center for Cardiovascular Medicine, Klinikstrasse 6-8, D-97070 Würzburg, Germany. Tel.: +49 931 201 36147; fax: +49 931 201 70380. E-mail address: stoerk_s{at}klinik.uni-wuerzburg.de (S. Störk)
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Abstract |
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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.
Key Words: Chronic heart failure • Pharmacotherapy • Prognosis • Survival • Left ventricular function
Received March 20, 2008; Revised July 3, 2008; Accepted September 22, 2008
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