Abstract
Background: Physician-related and patient-related factors play an important role in the suboptimal implementation of heart failure (HF) guideline-recommended therapy into real clinical practice. The aim of this study was to evaluate the impact of physicians' and patients' adherence to guideline-recommended therapy on all-cause death and HF re-hospitalization rates in patients with HF. Methods: This study was part of the international multicenter Optimize Heart Failure Care Program. 635 patients (mean age 61.6±12 years, 72% male, 75.6% with sinus rhythm) hospitalized with decompensated HF, NYHA II-IV (mean 2.8±0.6), mean LVEF 33.6±9.1%, were included. To assess physicians' adherence to the medications recommended by the 2016 ESC HF guidelines, a five-class guideline adherence score for angiotensin converting enzyme inhibitors (ACEIs), beta-blockers (BBs), angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists (MRAs), and ivabradine was used. The score was calculated for each patient by summing up points, which were attributed as follows: 0 for non-prescription in the absence of specified contraindications, and one point each for the use of ACEIs, ARBs, BBs, MRAs, and ivabradine if indicated. Patients' adherence to recommended medications was assessed using a method based on patient-reported compliance. Adherence was classified as good if patients always took all prescribed medications at target doses, moderate if sometimes patients didn't take one class of medications or took them at suboptimal doses, and poor if patients did not take any of the prescribed medications.