Copyright © 2003 by the European Society of Cardiology.
The EuroHeart Failure Survey programme—a survey on the quality of care among patients with heart failure in Europe
Part 2: treatment
The Study Group of Diagnosis of the Working Group on Heart Failure of the European Society of Cardiology*,a Paris, France;b Zürich, Switzerland;c Göteborg, Sweden;d Kingston upon Hull, UK;e Valencia, Spain;f Clichy, France;g Berlin, Germany;h Bergamo, Italy;i Groningen, The Netherlands;j Birmingham, UK;k Warsaw, Poland;l Lisbon, Portugal;m Moscow, Russia;n Budapest, Hungary;o Prague, Czech Republic;p Department of Primary Care & General Practice, University of Birmingham, UK;q Practice, Newcastle, UK
Received September 6, 2002; accepted September 18, 2002 * Corresponding author. Michel Komajda, Institut de Cardiologie, GH Pitié-Salpêtrière, 47-83 Bld de l'Hôpital, 75013 Paris, France.
E-mail address: j.g.cleland{at}hull.ac.uk
Background National surveys suggest that treatment of heart failure in daily practice differs from guidelines and is characterized by underuse of recommended medications. Accordingly, the Euro Heart Failure Survey was conducted to ascertain how patients hospitalized for heart failure are managed in Europe and if national variations occur in the treatment of this condition.
Methods The survey screened discharge summaries of 11 304 patients over a 6-week period in 115 hospitals from 24 countries belonging to the ESC to study their medical treatment.
Results Diuretics (mainly loop diuretics) were prescribed in 86.9% followed by ACE inhibitors (61.8%), beta-blockers (36.9%), cardiac glycosides (35.7%), nitrates (32.1%), calcium channel blockers (21.2%) and spironolactone (20.5%). 44.6% of the population used four or more different drugs. Only 17.2% were under the combination of diuretic, ACE inhibitors and beta-blockers. Important local variations were found in the rate of prescription of ACE inhibitors and particularly beta-blockers. Daily dosage of ACE inhibitors and particularly of beta-blockers was on average below the recommended target dose. Modelling-analysis of the prescription of treatments indicated that the aetiology of heart failure, age, co-morbid factors and type of hospital ward influenced the rate of prescription. Age <70 years, male gender and ischaemic aetiology were associated with an increased odds ratio for receiving an ACE inhibitor. Prescription of ACE inhibitors was also greater in diabetic patients and in patients with low ejection fraction (<40%) and lower in patients with renal dysfunction. The odds ratio for receiving a beta-blocker was reduced in patients >70 years, in patients with respiratory disease and increased in cardiology wards, in ischaemic heart failure and in male subjects. Prescription of cardiac glycosides was significantly increased in patients with supraventricular tachycardia/atrial fibrillation. Finally, the rate of prescription of antithrombotic agents was increased in the presence of supraventricular arrhythmia, ischaemic heart disease, male subjects but was decreased in patients over 70.
Conclusion Our results suggest that the prescription of recommended medications including ACE inhibitors and beta-blockers remains limited and that the daily dosage remains low, particularly for beta-blockers. The survey also identifies several important factors including age, gender, type of hospital ward, co morbid factors which influence the prescription of heart failure medication at discharge.
Key Words: Heart failure • Medical treatment • Survey
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A M Clark, I N Findlay, and for the Have a Heart Paisley IT Group Improving evidence based cardiac care and policy implementation over the patient journey: the potential of coronary heart disease registers Heart, September 1, 2005; 91(9): 1127 - 1130. [Abstract] [Full Text] [PDF]
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M. Komajda, P. Lapuerta, N. Hermans, J. R. Gonzalez-Juanatey, D. J. van Veldhuisen, E. Erdmann, L. Tavazzi, P. Poole-Wilson, and C. Le Pen Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey Eur. Heart J., August 2, 2005; 26(16): 1653 - 1659. [Abstract] [Full Text] [PDF]
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I. Ekman, J. G.F. Cleland, B. Andersson, and K. Swedberg Exploring symptoms in chronic heart failure Eur J Heart Fail, August 1, 2005; 7(5): 699 - 703. [Abstract] [Full Text] [PDF]
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J. McMurray, A. Cohen-Solal, R. Dietz, E. Eichhorn, L. Erhardt, F.D. R. Hobbs, H. Krum, A. Maggioni, R. S. McKelvie, I. L. Pina, et al. Practical recommendations for the use of ACE inhibitors, beta-blockers, aldosterone antagonists and angiotensin receptor blockers in heart failure: Putting guidelines into practice Eur J Heart Fail, August 1, 2005; 7(5): 710 - 721. [Abstract] [Full Text] [PDF]
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A L Clark and J G F Cleland Multidisciplinary interventions in heart failure Heart, July 1, 2005; 91(7): 849 - 850. [Abstract] [Full Text] [PDF]
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J.-P. Bassand, S. Priori, and M. Tendera Evidence-based vs. 'impressionist' medicine: how best to implement guidelines Eur. Heart J., June 2, 2005; 26(12): 1155 - 1158. [Abstract] [Full Text] [PDF]
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M. Hulsmann, R. Berger, D. Mortl, O. Gore, B. Meyer, and R. Pacher Incidence of normal values of natriuretic peptides in patients with chronic heart failure and impact on survival: A direct comparison of N-terminal atrial natriuretic peptide, N-terminal brain natriuretic peptide and brain natriuretic peptide Eur J Heart Fail, June 1, 2005; 7(4): 552 - 556. [Abstract] [Full Text] [PDF]
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M. Hulsmann, R. Berger, D. Mortl, and R. Pacher Influence of age and in-patient care on prescription rate and long-term outcome in chronic heart failure: a data-based substudy of the EuroHeart Failure Survey Eur J Heart Fail, June 1, 2005; 7(4): 657 - 661. [Abstract] [Full Text] [PDF]
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C. A. Daly, F. Clemens, J. L. L. Sendon, L. Tavazzi, E. Boersma, N. Danchin, F. Delahaye, A. Gitt, D. Julian, D. Mulcahy, et al. The clinical characteristics and investigations planned in patients with stable angina presenting to cardiologists in Europe: from the Euro Heart Survey of Stable Angina Eur. Heart J., May 2, 2005; 26(10): 996 - 1010. [Abstract] [Full Text] [PDF]
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T A McDonagh Lessons from the management of chronic heart failure Heart, May 1, 2005; 91(suppl_2): ii24 - ii27. [Abstract] [Full Text] [PDF]
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M. Gheorghiade and F. Zannad Modern management of acute heart failure syndromes Eur. Heart J. Suppl., April 1, 2005; 7(suppl_B): B3 - B7. [Abstract] [Full Text] [PDF]
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M. Gheorghiade and G. Filippatos Reassessing treatment of acute heart failure syndromes: the ADHERE Registry Eur. Heart J. Suppl., April 1, 2005; 7(suppl_B): B13 - B19. [Abstract] [Full Text] [PDF]
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T. Jaarsma, F. M. Haaijer-Ruskamp, H. Sturm, and D. J. Van Veldhuisen Management of heart failure in The Netherlands Eur J Heart Fail, March 16, 2005; 7(3): 371 - 375. [Abstract] [Full Text] [PDF]
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A. Jain, P. Mills, L. M. Nunn, J. Butler, L. Luddington, V. Ross, P. Cliffe, K. Ranjadayalan, and A. D. Timmis Success of a multidisciplinary heart failure clinic for initiation and up-titration of key therapeutic agents Eur J Heart Fail, March 16, 2005; 7(3): 405 - 410. [Abstract] [Full Text] [PDF]
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D. Goyal, R. J. Macfadyen, R. D. Watson, and G. Y.H. Lip Ambulatory blood pressure monitoring in heart failure: a systematic review Eur J Heart Fail, March 2, 2005; 7(2): 149 - 156. [Abstract] [Full Text] [PDF]
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J. McMurray Making sense of SENIORS Eur. Heart J., February 1, 2005; 26(3): 203 - 206. [Full Text] [PDF]
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J. J.V. McMurray and M. A. Pfeffer The year in heart failure J. Am. Coll. Cardiol., December 21, 2004; 44(12): 2398 - 2405. [Full Text] [PDF]
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J. B. Young, M. E. Dunlap, M. A. Pfeffer, J. L. Probstfield, A. Cohen-Solal, R. Dietz, C. B. Granger, J. Hradec, J. Kuch, R. S. McKelvie, et al. Mortality and Morbidity Reduction With Candesartan in Patients With Chronic Heart Failure and Left Ventricular Systolic Dysfunction: Results of the CHARM Low-Left Ventricular Ejection Fraction Trials Circulation, October 26, 2004; 110(17): 2618 - 2626. [Abstract] [Full Text] [PDF]
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