Analysis of Physician Compliance with Guideline-Directed Medical Therapy for Patients with Heart Failure with Reduced Ejection Fraction: A Real-World Study
Background: Although compliance with the guideline recommendations for heart failure (HF) is associated with improved survival, the effects of medication on clinical practice often fail to meet expectations due to physician and/or patient-related reasons that are unclear. This study analyzed physici...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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IMR Press
2023-09-01
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| Series: | Reviews in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.imrpress.com/journal/RCM/24/9/10.31083/j.rcm2409257 |
| _version_ | 1797672522421895168 |
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| author | Guixia Wang Liming Liu Xiaobo Wang Ting Yu Hui Xu Tingjun Zhang Jiafu Lin Hao Luo Yanxu Liu Lanxiang Jiang Wenlong Hu Houxiang Hu |
| author_facet | Guixia Wang Liming Liu Xiaobo Wang Ting Yu Hui Xu Tingjun Zhang Jiafu Lin Hao Luo Yanxu Liu Lanxiang Jiang Wenlong Hu Houxiang Hu |
| author_sort | Guixia Wang |
| collection | DOAJ |
| description | Background: Although compliance with the guideline recommendations for heart failure (HF) is associated with improved survival, the effects of medication on clinical practice often fail to meet expectations due to physician and/or patient-related reasons that are unclear. This study analyzed physicians’ compliance with guideline-directed medical therapy (GDMT) based on real-world clinical data and identified risk factors of low compliance. Methods: This study included patients with HF, who were treated at the Affiliated Hospital of North Sichuan Medical College from July 2017 to June 2021. All patients were divided into high compliance, moderate compliance, and low compliance with GDMT groups. The proportion of patients receiving treatment in compliance with GDMT was analyzed, the relationship between compliance with GDMT and clinical outcomes was evaluated, and the risk factors of low compliance were identified. Results: Of all patients with HF included in the study, 498 (23.8%) had low compliance with GDMT, 1413 (67.4%) had moderate compliance with GDMT, and 185 (8.8%) had high compliance with GDMT. The readmission rate of patients in the moderate compliance with GDMT group was significantly higher than that in the high and low compliance groups (p = 0.028). There were no significant differences in the rates of severe cardiovascular disease among the three groups. The mortality rate of patients in the high compliance with GDMT group was significantly higher than that of the other groups (p < 0.001). We found that a history of hypertension; New York Heart Association (NYHA) classification (III and IV vs. I); and abnormal heart rate, high-sensitive troponin T (hsTnT), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), uric acid, and left ventricular diastolic dysfunction (LVDD) were all significantly associated with low compliance with GDMT. Conclusions: The proportion of physicians’ compliance with GDMT in treating patients with HF is low. Risk factors of low compliance include hypertension; NYHA classification (III and IV vs. I); and abnormal heart rate, hsTnT, NT proBNP, uric acid, and LVDD. |
| first_indexed | 2024-03-11T21:31:18Z |
| format | Article |
| id | doaj.art-e08e2d21949542339c1c94255e520127 |
| institution | Directory Open Access Journal |
| issn | 1530-6550 |
| language | English |
| last_indexed | 2024-03-11T21:31:18Z |
| publishDate | 2023-09-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Reviews in Cardiovascular Medicine |
| spelling | doaj.art-e08e2d21949542339c1c94255e5201272023-09-27T09:29:52ZengIMR PressReviews in Cardiovascular Medicine1530-65502023-09-0124925710.31083/j.rcm2409257S1530-6550(23)00966-3Analysis of Physician Compliance with Guideline-Directed Medical Therapy for Patients with Heart Failure with Reduced Ejection Fraction: A Real-World StudyGuixia Wang0Liming Liu1Xiaobo Wang2Ting Yu3Hui Xu4Tingjun Zhang5Jiafu Lin6Hao Luo7Yanxu Liu8Lanxiang Jiang9Wenlong Hu10Houxiang Hu11The First Affiliated Hospital, Jinan University, 510630 Guangzhou, Guangdong, ChinaDepartment of Gerontology, Affiliated Hospital of North Sichuan Medical College, 2262110 Nanchong, Sichuan, ChinaDepartment of Cardiology, Affiliated Hospital of North Sichuan Medical College, 637002 Nanchong, Sichuan, ChinaInfectious Department, Affiliated Hospital of North Sichuan Medical College, 2262110 Nanchong, Sichuan, ChinaDepartment of Cardiology, Affiliated Hospital of North Sichuan Medical College, 637002 Nanchong, Sichuan, ChinaInfectious Department, Affiliated Hospital of North Sichuan Medical College, 2262110 Nanchong, Sichuan, ChinaInfectious Department, Affiliated Hospital of North Sichuan Medical College, 2262110 Nanchong, Sichuan, ChinaDepartment of Cardiology, Affiliated Hospital of North Sichuan Medical College, 637002 Nanchong, Sichuan, ChinaDepartment of Cardiology, Affiliated Hospital of North Sichuan Medical College, 637002 Nanchong, Sichuan, ChinaUndergraduate in Clinical Medicine, North Sichuan Medical College, 2262110 Nanchong, Sichuan, ChinaUndergraduate in Clinical Medicine, North Sichuan Medical College, 2262110 Nanchong, Sichuan, ChinaThe First Affiliated Hospital, Jinan University, 510630 Guangzhou, Guangdong, ChinaBackground: Although compliance with the guideline recommendations for heart failure (HF) is associated with improved survival, the effects of medication on clinical practice often fail to meet expectations due to physician and/or patient-related reasons that are unclear. This study analyzed physicians’ compliance with guideline-directed medical therapy (GDMT) based on real-world clinical data and identified risk factors of low compliance. Methods: This study included patients with HF, who were treated at the Affiliated Hospital of North Sichuan Medical College from July 2017 to June 2021. All patients were divided into high compliance, moderate compliance, and low compliance with GDMT groups. The proportion of patients receiving treatment in compliance with GDMT was analyzed, the relationship between compliance with GDMT and clinical outcomes was evaluated, and the risk factors of low compliance were identified. Results: Of all patients with HF included in the study, 498 (23.8%) had low compliance with GDMT, 1413 (67.4%) had moderate compliance with GDMT, and 185 (8.8%) had high compliance with GDMT. The readmission rate of patients in the moderate compliance with GDMT group was significantly higher than that in the high and low compliance groups (p = 0.028). There were no significant differences in the rates of severe cardiovascular disease among the three groups. The mortality rate of patients in the high compliance with GDMT group was significantly higher than that of the other groups (p < 0.001). We found that a history of hypertension; New York Heart Association (NYHA) classification (III and IV vs. I); and abnormal heart rate, high-sensitive troponin T (hsTnT), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), uric acid, and left ventricular diastolic dysfunction (LVDD) were all significantly associated with low compliance with GDMT. Conclusions: The proportion of physicians’ compliance with GDMT in treating patients with HF is low. Risk factors of low compliance include hypertension; NYHA classification (III and IV vs. I); and abnormal heart rate, hsTnT, NT proBNP, uric acid, and LVDD.https://www.imrpress.com/journal/RCM/24/9/10.31083/j.rcm2409257heart failureguideline-directed medical therapycompliancereal-world study |
| spellingShingle | Guixia Wang Liming Liu Xiaobo Wang Ting Yu Hui Xu Tingjun Zhang Jiafu Lin Hao Luo Yanxu Liu Lanxiang Jiang Wenlong Hu Houxiang Hu Analysis of Physician Compliance with Guideline-Directed Medical Therapy for Patients with Heart Failure with Reduced Ejection Fraction: A Real-World Study Reviews in Cardiovascular Medicine heart failure guideline-directed medical therapy compliance real-world study |
| title | Analysis of Physician Compliance with Guideline-Directed Medical Therapy for Patients with Heart Failure with Reduced Ejection Fraction: A Real-World Study |
| title_full | Analysis of Physician Compliance with Guideline-Directed Medical Therapy for Patients with Heart Failure with Reduced Ejection Fraction: A Real-World Study |
| title_fullStr | Analysis of Physician Compliance with Guideline-Directed Medical Therapy for Patients with Heart Failure with Reduced Ejection Fraction: A Real-World Study |
| title_full_unstemmed | Analysis of Physician Compliance with Guideline-Directed Medical Therapy for Patients with Heart Failure with Reduced Ejection Fraction: A Real-World Study |
| title_short | Analysis of Physician Compliance with Guideline-Directed Medical Therapy for Patients with Heart Failure with Reduced Ejection Fraction: A Real-World Study |
| title_sort | analysis of physician compliance with guideline directed medical therapy for patients with heart failure with reduced ejection fraction a real world study |
| topic | heart failure guideline-directed medical therapy compliance real-world study |
| url | https://www.imrpress.com/journal/RCM/24/9/10.31083/j.rcm2409257 |
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