Differences in guideline-recommended heart failure medication between Dutch heart failure clinics: an analysis of the CHECK-HF registry
Netherlands Heart Journal, vol. 28, pp. 334–344
Abstract
BACKGROUND: Heart failure (HF) is associated with poor prognosis, high morbidity and mortality. The prognosis can be optimised by guideline adherence, which also can be used as a benchmark of quality of care. The purpose of this study was to evaluate differences in use of HF medication between Dutch HF clinics. METHODS: The current analysis was part of a cross-sectional registry of 10,910 chronic HF patients at 34 Dutch outpatient clinics in the period of 2013 until 2016 (CHECK-HF), and focused on the differences in prescription rates between the participating clinics in patients with heart failure with reduced ejection fraction (HFrEF). RESULTS: A total of 8,360 HFrEF patients were included with a mean age of 72.3 ± 11.8 years (ranging between 69.1 ± 11.9 and 76.6 ± 10.0 between the clinics), 63.9% were men (ranging between 54.3 and 78.1%), 27.3% were in New York Heart Association (NYHA) class III/IV (ranging between 8.8 and 62.1%) and the average estimated glomerular filtration rate (eGFR) was 59.6 ± 24.6 ml/min (ranging between 45.7 ± 23.5 and 97.1 ± 16.5). The prescription rates ranged from 58.9-97.4% for beta blockers (p < 0.01), 61.9-97.1% for renin-angiotensin system (RAS) inhibitors (p < 0.01), 29.9-86.8% for mineralocorticoid receptor antagonists (MRAs) (p < 0.01), 0.0-31.3% for ivabradine (p < 0.01) and 64.9-100.0% for diuretics (p < 0.01). Also, the percentage of patients who received the target dose differed significantly, 5.9-29.1% for beta blockers (p < 0.01), 18.4-56.1% for RAS inhibitors (p < 0.01) and 13.2-60.6% for MRAs (p < 0.01). CONCLUSIONS: The prescription rates and prescribed dosages of guideline-recommended medication differed significantly between HF outpatient clinics in the Netherlands, not fully explained by differences in patient profiles.
Authors 9
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Gerard C.M. Linssen corresponding
Erasmus MC · Ziekenhuis Groep Twente
Affiliation as printed
Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, Almelo, The Netherlands. g.linssen@zgt.nl
Erasmus Medical Center, Department of Cardiology, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Maastricht University Medical Centre · Erasmus MC
Affiliation as printed
Erasmus Medical Center, Department of Cardiology, University Medical Center Rotterdam, Rotterdam, The Netherlands
Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
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Maastricht University Medical Centre · Alrijne Ziekenhuis
Affiliation as printed
Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
Department of Cardiology, Alrijne Ziekenhuis, Leiderdorp, The Netherlands
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Alrijne Ziekenhuis · Diakonessenhuis hospital
Affiliation as printed
CONNECT-HF Program, Netherlands Society of Cardiology, Utrecht, The Netherlands
Department of Cardiology, Alrijne Ziekenhuis, Leiderdorp, The Netherlands
Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands
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St. Antonius Ziekenhuis · Diakonessenhuis hospital
Affiliation as printed
Department of Cardiology, Diakonessenhuis, Utrecht, The Netherlands
Department of Cardiology, St. Antonius ziekenhuis, Nieuwegein, The Netherlands
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Affiliation as printed
Department of Cardiology, St. Antonius ziekenhuis, Nieuwegein, The Netherlands
Department of Cardiology, Maasziekenhuis Pantein, Beugen (Boxmeer), The Netherlands
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Utrecht University · University Medical Center Utrecht
Affiliation as printed
Department of Cardiology, Maasziekenhuis Pantein, Beugen (Boxmeer), The Netherlands
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
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Utrecht University · Erasmus MC · University Medical Center Utrecht
Affiliation as printed
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht and Utrecht University, Utrecht, The Netherlands
Erasmus Medical Center, Department of Cardiology, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Affiliation as printed
Erasmus Medical Center, Department of Cardiology, University Medical Center Rotterdam, Rotterdam, The Netherlands
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