Physicians' Academy for Cardiovascular Education

Physician adherence to guidelines associated with improved heart failure outcomes

Physicians’ guideline adherence is associated with better prognosis in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry

Literature - Komajda M, Cowie MR, Tavazzi L, et al; QUALIFY Investigators - Eur J Heart Fail. 2017; published online ahead of print


The prescription of evidence-based therapies at appropriate doses, which are recommended by international guidelines, is the most effective way of ensuring that patients receive optimal care [1-4]. However, there is evidence showing that a large proportion of heart failure (HF) patients do not receive evidence-based treatments. For example, it has been reported that only a median of 27% of patients receive all HF therapies for which they are potentially eligible, and that only 42% of HF patients are discharged on angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs), beta-blockers and mineralocorticoid receptor antagonists (MRAs) [5].

In this analysis of the international QUALIFY survey, the impact of physicians’ adherence to guideline-recommended classes and doses of HF medications on clinical outcomes was evaluated at a 6-month follow-up. 6669 HF patients with reduced ejection fraction (HFrEF) were categorized as good adherence (23%), moderate adherence (55%) or poor adherence (22%) to 5 classes of medication (ACEIs, ARBs, beta-blockers, MRAs and ivabradine).

Main results


Good adherence of physicians to treatment guidelines, in particular prescription of ACEIs/ARBs, beta-blockers, MRAs and ivabradine, in dosages at least 50% of those recommended, is associated with improved mid-term clinical outcomes. These findings support the full implementation of guideline recommendations in clinical practice and suggest that quality performance metrics for HF in hospitals or healthcare systems should involve global adherence to all medications and dosages.


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Find this article online at Eur J Heart Fail.

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