Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey
Identifieur interne : 001449 ( Istex/Corpus ); précédent : 001448; suivant : 001450Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey
Auteurs : Michel Komajda ; Pablo Lapuerta ; Nancy Hermans ; Jose Ramon Gonzalez-Juanatey ; Dirk J. Van Veldhuisen ; Erland Erdmann ; Luigi Tavazzi ; Philip Poole-Wilson ; Claude Le PenSource :
- European Heart Journal [ 0195-668X ] ; 2005-08.
English descriptors
- KwdEn :
Abstract
Aims The impact on outcome of the implementation of European guidelines for the treatment of chronic heart failure (CHF) has not been evaluated. We investigated the consequences of adherence to care by cardiologists on the rate of CHF and cardiovascular (CV) hospitalizations and time to CV hospitalization. Methods and results We constructed class adherence indicators for angiotensin-converting enzyme (ACE)-inhibitors, beta-blockers, spironolactone, diuretics, and cardiac glycosides and GAIs (GAI3 adherence to first three classes of heart failure medication, GAI5 adherence to five classes). In the study, 1410 evaluable patients (mean age 69, 69% males, New York Heart Association (NYHA) II: 64%, III: 34%, IV: 2%) were enrolled and followed up for 6 months by 150 randomly selected cardiologists/cardiology departments from six European countries (France, Germany, Italy, The Netherlands, Spain, and UK). Overall, adherence to treatment guidelines was 60 (GAI3) and 63% (GAI5) and was better for ACE-I (88%) or diuretics (82%) than for cardiac glycosides (52%), beta-blockers (58%), and spironolactone (36%). In the three tertiles of the population defined by a decreasing mean adherence score value, CHF and CV hospitalization rates were, respectively, 6.7, 9.7, and 14.7% and 11.2, 15.9, and 20.6% (P<0.002 and P<0.001, respectively). Global adherence indicator GAI3 was an independent predictor of time to CV hospitalization in a multi-variable model together with NYHA Class, history of CHF hospitalization, ischaemic aetiology, diabetes mellitus, and hypertension. Conclusion We demonstrate that adherence of physicians to treatment guidelines is a strong predictor of fewer CV hospitalizations in actual practice. There is a need to develop further quality improvement programmes in this condition.
Url:
DOI: 10.1093/eurheartj/ehi251
Links to Exploration step
ISTEX:691076912B713CA68524612817A2BBC2EEE09DCCLe document en format XML
<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey</title><author><name sortKey="Komajda, Michel" sort="Komajda, Michel" uniqKey="Komajda M" first="Michel" last="Komajda">Michel Komajda</name><affiliation><mods:affiliation>Department of Cardiology, Pitie-Salpetriere Hospital, 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France</mods:affiliation></affiliation><affiliation><mods:affiliation></mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: </mods:affiliation></affiliation></author><author><name sortKey="Lapuerta, Pablo" sort="Lapuerta, Pablo" uniqKey="Lapuerta P" first="Pablo" last="Lapuerta">Pablo Lapuerta</name><affiliation><mods:affiliation>Bristol-Myers-Squibb Outcomes Research, Brussels, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Hermans, Nancy" sort="Hermans, Nancy" uniqKey="Hermans N" first="Nancy" last="Hermans">Nancy Hermans</name><affiliation><mods:affiliation>Bristol-Myers-Squibb Outcomes Research, Brussels, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Gonzalez Juanatey, Jose Ramon" sort="Gonzalez Juanatey, Jose Ramon" uniqKey="Gonzalez Juanatey J" first="Jose Ramon" last="Gonzalez-Juanatey">Jose Ramon Gonzalez-Juanatey</name><affiliation><mods:affiliation>Department of Cardiology, Hospital Clinico Universitario de Santiago de Compostela, Spain</mods:affiliation></affiliation></author><author><name sortKey="Van Veldhuisen, Dirk J" sort="Van Veldhuisen, Dirk J" uniqKey="Van Veldhuisen D" first="Dirk J." last="Van Veldhuisen">Dirk J. Van Veldhuisen</name><affiliation><mods:affiliation>Department of Cardiology, University Hospital Groningen, Groningen, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Erdmann, Erland" sort="Erdmann, Erland" uniqKey="Erdmann E" first="Erland" last="Erdmann">Erland Erdmann</name><affiliation><mods:affiliation>Department of Medicine III, University of Cologne, Germany</mods:affiliation></affiliation></author><author><name sortKey="Tavazzi, Luigi" sort="Tavazzi, Luigi" uniqKey="Tavazzi L" first="Luigi" last="Tavazzi">Luigi Tavazzi</name><affiliation><mods:affiliation>Division of Cardiology, IRCCS Policlinico San Matteo Hospital, Pavia, Italy</mods:affiliation></affiliation></author><author><name sortKey="Poole Wilson, Philip" sort="Poole Wilson, Philip" uniqKey="Poole Wilson P" first="Philip" last="Poole-Wilson">Philip Poole-Wilson</name><affiliation><mods:affiliation>National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Le Pen, Claude" sort="Le Pen, Claude" uniqKey="Le Pen C" first="Claude" last="Le Pen">Claude Le Pen</name><affiliation><mods:affiliation>CLP Santé, Paris, France</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:691076912B713CA68524612817A2BBC2EEE09DCC</idno><date when="2005" year="2005">2005</date><idno type="doi">10.1093/eurheartj/ehi251</idno><idno type="url">https://api.istex.fr/document/691076912B713CA68524612817A2BBC2EEE09DCC/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001449</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey</title><author><name sortKey="Komajda, Michel" sort="Komajda, Michel" uniqKey="Komajda M" first="Michel" last="Komajda">Michel Komajda</name><affiliation><mods:affiliation>Department of Cardiology, Pitie-Salpetriere Hospital, 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France</mods:affiliation></affiliation><affiliation><mods:affiliation></mods:affiliation></affiliation><affiliation><mods:affiliation>E-mail: </mods:affiliation></affiliation></author><author><name sortKey="Lapuerta, Pablo" sort="Lapuerta, Pablo" uniqKey="Lapuerta P" first="Pablo" last="Lapuerta">Pablo Lapuerta</name><affiliation><mods:affiliation>Bristol-Myers-Squibb Outcomes Research, Brussels, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Hermans, Nancy" sort="Hermans, Nancy" uniqKey="Hermans N" first="Nancy" last="Hermans">Nancy Hermans</name><affiliation><mods:affiliation>Bristol-Myers-Squibb Outcomes Research, Brussels, Belgium</mods:affiliation></affiliation></author><author><name sortKey="Gonzalez Juanatey, Jose Ramon" sort="Gonzalez Juanatey, Jose Ramon" uniqKey="Gonzalez Juanatey J" first="Jose Ramon" last="Gonzalez-Juanatey">Jose Ramon Gonzalez-Juanatey</name><affiliation><mods:affiliation>Department of Cardiology, Hospital Clinico Universitario de Santiago de Compostela, Spain</mods:affiliation></affiliation></author><author><name sortKey="Van Veldhuisen, Dirk J" sort="Van Veldhuisen, Dirk J" uniqKey="Van Veldhuisen D" first="Dirk J." last="Van Veldhuisen">Dirk J. Van Veldhuisen</name><affiliation><mods:affiliation>Department of Cardiology, University Hospital Groningen, Groningen, The Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Erdmann, Erland" sort="Erdmann, Erland" uniqKey="Erdmann E" first="Erland" last="Erdmann">Erland Erdmann</name><affiliation><mods:affiliation>Department of Medicine III, University of Cologne, Germany</mods:affiliation></affiliation></author><author><name sortKey="Tavazzi, Luigi" sort="Tavazzi, Luigi" uniqKey="Tavazzi L" first="Luigi" last="Tavazzi">Luigi Tavazzi</name><affiliation><mods:affiliation>Division of Cardiology, IRCCS Policlinico San Matteo Hospital, Pavia, Italy</mods:affiliation></affiliation></author><author><name sortKey="Poole Wilson, Philip" sort="Poole Wilson, Philip" uniqKey="Poole Wilson P" first="Philip" last="Poole-Wilson">Philip Poole-Wilson</name><affiliation><mods:affiliation>National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK</mods:affiliation></affiliation></author><author><name sortKey="Le Pen, Claude" sort="Le Pen, Claude" uniqKey="Le Pen C" first="Claude" last="Le Pen">Claude Le Pen</name><affiliation><mods:affiliation>CLP Santé, Paris, France</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">European Heart Journal</title><title level="j" type="abbrev">Eur Heart J</title><idno type="ISSN">0195-668X</idno><idno type="eISSN">1522-9645</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2005-08">2005-08</date><biblScope unit="volume">26</biblScope><biblScope unit="issue">16</biblScope><biblScope unit="page" from="1653">1653</biblScope><biblScope unit="page" to="1659">1659</biblScope></imprint><idno type="ISSN">0195-668X</idno></series><idno type="istex">691076912B713CA68524612817A2BBC2EEE09DCC</idno><idno type="DOI">10.1093/eurheartj/ehi251</idno><idno type="href">ehi251</idno><idno type="local">ehi251</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0195-668X</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Care indicators</term><term>Chronic heart failure</term><term>Guidelines</term><term>Outcome</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Aims The impact on outcome of the implementation of European guidelines for the treatment of chronic heart failure (CHF) has not been evaluated. We investigated the consequences of adherence to care by cardiologists on the rate of CHF and cardiovascular (CV) hospitalizations and time to CV hospitalization. Methods and results We constructed class adherence indicators for angiotensin-converting enzyme (ACE)-inhibitors, beta-blockers, spironolactone, diuretics, and cardiac glycosides and GAIs (GAI3 adherence to first three classes of heart failure medication, GAI5 adherence to five classes). In the study, 1410 evaluable patients (mean age 69, 69% males, New York Heart Association (NYHA) II: 64%, III: 34%, IV: 2%) were enrolled and followed up for 6 months by 150 randomly selected cardiologists/cardiology departments from six European countries (France, Germany, Italy, The Netherlands, Spain, and UK). Overall, adherence to treatment guidelines was 60 (GAI3) and 63% (GAI5) and was better for ACE-I (88%) or diuretics (82%) than for cardiac glycosides (52%), beta-blockers (58%), and spironolactone (36%). In the three tertiles of the population defined by a decreasing mean adherence score value, CHF and CV hospitalization rates were, respectively, 6.7, 9.7, and 14.7% and 11.2, 15.9, and 20.6% (P<0.002 and P<0.001, respectively). Global adherence indicator GAI3 was an independent predictor of time to CV hospitalization in a multi-variable model together with NYHA Class, history of CHF hospitalization, ischaemic aetiology, diabetes mellitus, and hypertension. Conclusion We demonstrate that adherence of physicians to treatment guidelines is a strong predictor of fewer CV hospitalizations in actual practice. There is a need to develop further quality improvement programmes in this condition.</div></front></TEI><istex><corpusName>oup</corpusName><author><json:item><name>Michel Komajda</name><affiliations><json:string>Department of Cardiology, Pitie-Salpetriere Hospital, 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France</json:string><json:null></json:null><json:string>E-mail:</json:string><json:string>E-mail: michel.komajda@psl.ap-hop-paris.fr</json:string></affiliations></json:item><json:item><name>Pablo Lapuerta</name><affiliations><json:string>Bristol-Myers-Squibb Outcomes Research, Brussels, Belgium</json:string></affiliations></json:item><json:item><name>Nancy Hermans</name><affiliations><json:string>Bristol-Myers-Squibb Outcomes Research, Brussels, Belgium</json:string></affiliations></json:item><json:item><name>José Ramon Gonzalez-Juanatey</name><affiliations><json:string>Department of Cardiology, Hospital Clinico Universitario de Santiago de Compostela, Spain</json:string></affiliations></json:item><json:item><name>Dirk J. van Veldhuisen</name><affiliations><json:string>Department of Cardiology, University Hospital Groningen, Groningen, The Netherlands</json:string></affiliations></json:item><json:item><name>Erland Erdmann</name><affiliations><json:string>Department of Medicine III, University of Cologne, Germany</json:string></affiliations></json:item><json:item><name>Luigi Tavazzi</name><affiliations><json:string>Division of Cardiology, IRCCS Policlinico San Matteo Hospital, Pavia, Italy</json:string></affiliations></json:item><json:item><name>Philip Poole-Wilson</name><affiliations><json:string>National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK</json:string></affiliations></json:item><json:item><name>Claude Le Pen</name><affiliations><json:string>CLP Santé, Paris, France</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Guidelines</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Chronic heart failure</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Care indicators</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Outcome</value></json:item></subject><language><json:string>eng</json:string></language><originalGenre><json:string>other</json:string></originalGenre><abstract>Aims The impact on outcome of the implementation of European guidelines for the treatment of chronic heart failure (CHF) has not been evaluated. We investigated the consequences of adherence to care by cardiologists on the rate of CHF and cardiovascular (CV) hospitalizations and time to CV hospitalization. Methods and results We constructed class adherence indicators for angiotensin-converting enzyme (ACE)-inhibitors, beta-blockers, spironolactone, diuretics, and cardiac glycosides and GAIs (GAI3 adherence to first three classes of heart failure medication, GAI5 adherence to five classes). In the study, 1410 evaluable patients (mean age 69, 69% males, New York Heart Association (NYHA) II: 64%, III: 34%, IV: 2%) were enrolled and followed up for 6 months by 150 randomly selected cardiologists/cardiology departments from six European countries (France, Germany, Italy, The Netherlands, Spain, and UK). Overall, adherence to treatment guidelines was 60 (GAI3) and 63% (GAI5) and was better for ACE-I (88%) or diuretics (82%) than for cardiac glycosides (52%), beta-blockers (58%), and spironolactone (36%). In the three tertiles of the population defined by a decreasing mean adherence score value, CHF and CV hospitalization rates were, respectively, 6.7, 9.7, and 14.7% and 11.2, 15.9, and 20.6% (P>0.002 and P>0.001, respectively). Global adherence indicator GAI3 was an independent predictor of time to CV hospitalization in a multi-variable model together with NYHA Class, history of CHF hospitalization, ischaemic aetiology, diabetes mellitus, and hypertension. Conclusion We demonstrate that adherence of physicians to treatment guidelines is a strong predictor of fewer CV hospitalizations in actual practice. There is a need to develop further quality improvement programmes in this condition.</abstract><qualityIndicators><score>7.76</score><pdfVersion>1.2</pdfVersion><pdfPageSize>595 x 794 pts</pdfPageSize><refBibsNative>false</refBibsNative><keywordCount>4</keywordCount><abstractCharCount>1811</abstractCharCount><pdfWordCount>4760</pdfWordCount><pdfCharCount>31807</pdfCharCount><pdfPageCount>7</pdfPageCount><abstractWordCount>260</abstractWordCount></qualityIndicators><title>Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey</title><genre><json:string>other</json:string></genre><host><volume>26</volume><publisherId><json:string>eurheartj</json:string></publisherId><pages><last>1659</last><first>1653</first></pages><issn><json:string>0195-668X</json:string></issn><issue>16</issue><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1522-9645</json:string></eissn><title>European Heart Journal</title></host><categories><wos><json:string>CARDIAC & CARDIOVASCULAR SYSTEMS</json:string></wos></categories><publicationDate>2005</publicationDate><copyrightDate>2005</copyrightDate><doi><json:string>10.1093/eurheartj/ehi251</json:string></doi><id>691076912B713CA68524612817A2BBC2EEE09DCC</id><score>0.12879977</score><fulltext><json:item><original>true</original><mimetype>application/pdf</mimetype><extension>pdf</extension><uri>https://api.istex.fr/document/691076912B713CA68524612817A2BBC2EEE09DCC/fulltext/pdf</uri></json:item><json:item><original>false</original><mimetype>application/zip</mimetype><extension>zip</extension><uri>https://api.istex.fr/document/691076912B713CA68524612817A2BBC2EEE09DCC/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/691076912B713CA68524612817A2BBC2EEE09DCC/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey</title><respStmt><resp>Références bibliographiques récupérées via GROBID</resp><name resp="ISTEX-API">ISTEX-API (INIST-CNRS)</name></respStmt></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Oxford University Press</publisher><availability><p>© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org</p></availability><date>2005-04-12</date></publicationStmt><notesStmt><note>*Corresponding author. Tel: +33 1 4216 3003; fax: +33 1 4216 3020. E-mail address: michel.komajda@psl.ap-hop-paris.fr</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey</title><author xml:id="author-1"><persName><forename type="first">Michel</forename><surname>Komajda</surname></persName><email></email><affiliation>Department of Cardiology, Pitie-Salpetriere Hospital, 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France</affiliation><affiliation></affiliation></author><author xml:id="author-2"><persName><forename type="first">Pablo</forename><surname>Lapuerta</surname></persName><affiliation>Bristol-Myers-Squibb Outcomes Research, Brussels, Belgium</affiliation></author><author xml:id="author-3"><persName><forename type="first">Nancy</forename><surname>Hermans</surname></persName><affiliation>Bristol-Myers-Squibb Outcomes Research, Brussels, Belgium</affiliation></author><author xml:id="author-4"><persName><forename type="first">José Ramon</forename><surname>Gonzalez-Juanatey</surname></persName><affiliation>Department of Cardiology, Hospital Clinico Universitario de Santiago de Compostela, Spain</affiliation></author><author xml:id="author-5"><persName><forename type="first">Dirk J.</forename><surname>van Veldhuisen</surname></persName><affiliation>Department of Cardiology, University Hospital Groningen, Groningen, The Netherlands</affiliation></author><author xml:id="author-6"><persName><forename type="first">Erland</forename><surname>Erdmann</surname></persName><affiliation>Department of Medicine III, University of Cologne, Germany</affiliation></author><author xml:id="author-7"><persName><forename type="first">Luigi</forename><surname>Tavazzi</surname></persName><affiliation>Division of Cardiology, IRCCS Policlinico San Matteo Hospital, Pavia, Italy</affiliation></author><author xml:id="author-8"><persName><forename type="first">Philip</forename><surname>Poole-Wilson</surname></persName><affiliation>National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK</affiliation></author><author xml:id="author-9"><persName><forename type="first">Claude</forename><surname>Le Pen</surname></persName><affiliation>CLP Santé, Paris, France</affiliation></author></analytic><monogr><title level="j">European Heart Journal</title><title level="j" type="abbrev">Eur Heart J</title><idno type="pISSN">0195-668X</idno><idno type="eISSN">1522-9645</idno><imprint><publisher>Oxford University Press</publisher><date type="published" when="2005-08"></date><biblScope unit="volume">26</biblScope><biblScope unit="issue">16</biblScope><biblScope unit="page" from="1653">1653</biblScope><biblScope unit="page" to="1659">1659</biblScope></imprint></monogr><idno type="istex">691076912B713CA68524612817A2BBC2EEE09DCC</idno><idno type="DOI">10.1093/eurheartj/ehi251</idno><idno type="href">ehi251</idno><idno type="local">ehi251</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2005-04-12</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Aims The impact on outcome of the implementation of European guidelines for the treatment of chronic heart failure (CHF) has not been evaluated. We investigated the consequences of adherence to care by cardiologists on the rate of CHF and cardiovascular (CV) hospitalizations and time to CV hospitalization. Methods and results We constructed class adherence indicators for angiotensin-converting enzyme (ACE)-inhibitors, beta-blockers, spironolactone, diuretics, and cardiac glycosides and GAIs (GAI3 adherence to first three classes of heart failure medication, GAI5 adherence to five classes). In the study, 1410 evaluable patients (mean age 69, 69% males, New York Heart Association (NYHA) II: 64%, III: 34%, IV: 2%) were enrolled and followed up for 6 months by 150 randomly selected cardiologists/cardiology departments from six European countries (France, Germany, Italy, The Netherlands, Spain, and UK). Overall, adherence to treatment guidelines was 60 (GAI3) and 63% (GAI5) and was better for ACE-I (88%) or diuretics (82%) than for cardiac glycosides (52%), beta-blockers (58%), and spironolactone (36%). In the three tertiles of the population defined by a decreasing mean adherence score value, CHF and CV hospitalization rates were, respectively, 6.7, 9.7, and 14.7% and 11.2, 15.9, and 20.6% (P<0.002 and P<0.001, respectively). Global adherence indicator GAI3 was an independent predictor of time to CV hospitalization in a multi-variable model together with NYHA Class, history of CHF hospitalization, ischaemic aetiology, diabetes mellitus, and hypertension. Conclusion We demonstrate that adherence of physicians to treatment guidelines is a strong predictor of fewer CV hospitalizations in actual practice. There is a need to develop further quality improvement programmes in this condition.</p></abstract><textClass xml:lang="en"><keywords scheme="keyword"><list><head>KWD</head><item><term>Guidelines</term></item><item><term>Chronic heart failure</term></item><item><term>Care indicators</term></item><item><term>Outcome</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2005-04-12">Created</change><change when="2005-08">Published</change><change xml:id="refBibs-istex" who="#ISTEX-API" when="2016-10-14">References added</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><original>false</original><mimetype>text/plain</mimetype><extension>txt</extension><uri>https://api.istex.fr/document/691076912B713CA68524612817A2BBC2EEE09DCC/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus oup" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="US-ASCII"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article xml:lang="en" article-type="other"><front><journal-meta><journal-id journal-id-type="hwp">ehj</journal-id><journal-id journal-id-type="nlm-ta">Eur Heart J</journal-id><journal-id journal-id-type="publisher-id">eurheartj</journal-id><journal-title>European Heart Journal</journal-title><abbrev-journal-title abbrev-type="publisher">Eur Heart J</abbrev-journal-title><issn pub-type="ppub">0195-668X</issn><issn pub-type="epub">1522-9645</issn><publisher><publisher-name>Oxford University Press</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="other">ehi251</article-id><article-id pub-id-type="doi">10.1093/eurheartj/ehi251</article-id><article-categories><subj-group subj-group-type="heading"><subject>CLINICAL RESEARCH</subject></subj-group></article-categories><title-group><article-title>Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Komajda</surname><given-names>Michel</given-names></name><xref rid="AF1">1</xref><xref rid="COR1">*</xref></contrib><contrib contrib-type="author"><name><surname>Lapuerta</surname><given-names>Pablo</given-names></name><xref rid="AF2">2</xref></contrib><contrib contrib-type="author"><name><surname>Hermans</surname><given-names>Nancy</given-names></name><xref rid="AF2">2</xref></contrib><contrib contrib-type="author"><name><surname>Gonzalez-Juanatey</surname><given-names>José Ramon</given-names></name><xref rid="AF3">3</xref></contrib><contrib contrib-type="author"><name><surname>van Veldhuisen</surname><given-names>Dirk J.</given-names></name><xref rid="AF4">4</xref></contrib><contrib contrib-type="author"><name><surname>Erdmann</surname><given-names>Erland</given-names></name><xref rid="AF5">5</xref></contrib><contrib contrib-type="author"><name><surname>Tavazzi</surname><given-names>Luigi</given-names></name><xref rid="AF6">6</xref></contrib><contrib contrib-type="author"><name><surname>Poole-Wilson</surname><given-names>Philip</given-names></name><xref rid="AF7">7</xref></contrib><contrib contrib-type="author"><name><surname>Le Pen</surname><given-names>Claude</given-names></name><xref rid="AF8">8</xref></contrib><aff id="AF1"><sup>1</sup>Department of Cardiology, Pitie-Salpetriere Hospital, 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France</aff><aff id="AF2"><sup>2</sup>Bristol-Myers-Squibb Outcomes Research, Brussels, Belgium</aff><aff id="AF3"><sup>3</sup>Department of Cardiology, Hospital Clinico Universitario de Santiago de Compostela, Spain</aff><aff id="AF4"><sup>4</sup>Department of Cardiology, University Hospital Groningen, Groningen, The Netherlands</aff><aff id="AF5"><sup>5</sup>Department of Medicine III, University of Cologne, Germany</aff><aff id="AF6"><sup>6</sup>Division of Cardiology, IRCCS Policlinico San Matteo Hospital, Pavia, Italy</aff><aff id="AF7"><sup>7</sup>National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK</aff><aff id="AF8"><sup>8</sup>CLP Santé, Paris, France</aff></contrib-group><author-notes><corresp id="COR1"><label>*</label>Corresponding author. Tel: +33 1 4216 3003; fax: +33 1 4216 3020. <italic>E-mail address</italic>: <ext-link xlink:href="michel.komajda@psl.ap-hop-paris.fr" ext-link-type="email">michel.komajda@psl.ap-hop-paris.fr</ext-link></corresp></author-notes><pub-date pub-type="ppub"><month>August</month><year>2005</year></pub-date><pub-date pub-type="epub"><day>12</day><month>04</month><year>2005</year></pub-date><volume>26</volume><issue>16</issue><fpage>1653</fpage><lpage>1659</lpage><history><date date-type="accepted"><day>3</day><month>03</month><year>2005</year></date><date date-type="received"><day>20</day><month>08</month><year>2004</year></date><date date-type="rev-recd"><day>1</day><month>03</month><year>2005</year></date></history><permissions><copyright-statement>© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org</copyright-statement><copyright-year>2005</copyright-year></permissions><self-uri content-type="arthw-pdf" xlink:href="ehi251"></self-uri><abstract xml:lang="en"><p><bold>Aims</bold> The impact on outcome of the implementation of European guidelines for the treatment of chronic heart failure (CHF) has not been evaluated. We investigated the consequences of adherence to care by cardiologists on the rate of CHF and cardiovascular (CV) hospitalizations and time to CV hospitalization.</p><p><bold>Methods and results</bold> We constructed class adherence indicators for angiotensin-converting enzyme (ACE)-inhibitors, beta-blockers, spironolactone, diuretics, and cardiac glycosides and GAIs (GAI3 adherence to first three classes of heart failure medication, GAI5 adherence to five classes). In the study, 1410 evaluable patients (mean age 69, 69% males, New York Heart Association (NYHA) II: 64%, III: 34%, IV: 2%) were enrolled and followed up for 6 months by 150 randomly selected cardiologists/cardiology departments from six European countries (France, Germany, Italy, The Netherlands, Spain, and UK).</p><p>Overall, adherence to treatment guidelines was 60 (GAI3) and 63% (GAI5) and was better for ACE-I (88%) or diuretics (82%) than for cardiac glycosides (52%), beta-blockers (58%), and spironolactone (36%). In the three tertiles of the population defined by a decreasing mean adherence score value, CHF and CV hospitalization rates were, respectively, 6.7, 9.7, and 14.7% and 11.2, 15.9, and 20.6% (<italic>P</italic><0.002 and <italic>P</italic><0.001, respectively). Global adherence indicator GAI3 was an independent predictor of time to CV hospitalization in a multi-variable model together with NYHA Class, history of CHF hospitalization, ischaemic aetiology, diabetes mellitus, and hypertension.</p><p><bold>Conclusion</bold> We demonstrate that adherence of physicians to treatment guidelines is a strong predictor of fewer CV hospitalizations in actual practice. There is a need to develop further quality improvement programmes in this condition.</p></abstract><kwd-group kwd-group-type="KWD" xml:lang="en"><kwd>Guidelines</kwd><kwd>Chronic heart failure</kwd><kwd>Care indicators</kwd><kwd>Outcome</kwd></kwd-group><custom-meta-wrap><custom-meta><meta-name>hwp-legacy-fpage</meta-name><meta-value>1653</meta-value></custom-meta><custom-meta><meta-name>cover-date</meta-name><meta-value>August 2005</meta-value></custom-meta><custom-meta><meta-name>hwp-legacy-dochead</meta-name><meta-value>Clinical research</meta-value></custom-meta></custom-meta-wrap></article-meta></front></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey</title></titleInfo><name type="personal"><namePart type="given">Michel</namePart><namePart type="family">Komajda</namePart><affiliation>Department of Cardiology, Pitie-Salpetriere Hospital, 47-83 Boulevard de l'Hôpital, 75651 Paris Cedex 13, France</affiliation><affiliation></affiliation><affiliation>E-mail: </affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Pablo</namePart><namePart type="family">Lapuerta</namePart><affiliation>Bristol-Myers-Squibb Outcomes Research, Brussels, Belgium</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Nancy</namePart><namePart type="family">Hermans</namePart><affiliation>Bristol-Myers-Squibb Outcomes Research, Brussels, Belgium</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">José Ramon</namePart><namePart type="family">Gonzalez-Juanatey</namePart><affiliation>Department of Cardiology, Hospital Clinico Universitario de Santiago de Compostela, Spain</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Dirk J.</namePart><namePart type="family">van Veldhuisen</namePart><affiliation>Department of Cardiology, University Hospital Groningen, Groningen, The Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Erland</namePart><namePart type="family">Erdmann</namePart><affiliation>Department of Medicine III, University of Cologne, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Luigi</namePart><namePart type="family">Tavazzi</namePart><affiliation>Division of Cardiology, IRCCS Policlinico San Matteo Hospital, Pavia, Italy</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Philip</namePart><namePart type="family">Poole-Wilson</namePart><affiliation>National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Claude</namePart><namePart type="family">Le Pen</namePart><affiliation>CLP Santé, Paris, France</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="other" displayLabel="other"></genre><originInfo><publisher>Oxford University Press</publisher><dateIssued encoding="w3cdtf">2005-08</dateIssued><dateCreated encoding="w3cdtf">2005-04-12</dateCreated><copyrightDate encoding="w3cdtf">2005</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Aims The impact on outcome of the implementation of European guidelines for the treatment of chronic heart failure (CHF) has not been evaluated. We investigated the consequences of adherence to care by cardiologists on the rate of CHF and cardiovascular (CV) hospitalizations and time to CV hospitalization. Methods and results We constructed class adherence indicators for angiotensin-converting enzyme (ACE)-inhibitors, beta-blockers, spironolactone, diuretics, and cardiac glycosides and GAIs (GAI3 adherence to first three classes of heart failure medication, GAI5 adherence to five classes). In the study, 1410 evaluable patients (mean age 69, 69% males, New York Heart Association (NYHA) II: 64%, III: 34%, IV: 2%) were enrolled and followed up for 6 months by 150 randomly selected cardiologists/cardiology departments from six European countries (France, Germany, Italy, The Netherlands, Spain, and UK). Overall, adherence to treatment guidelines was 60 (GAI3) and 63% (GAI5) and was better for ACE-I (88%) or diuretics (82%) than for cardiac glycosides (52%), beta-blockers (58%), and spironolactone (36%). In the three tertiles of the population defined by a decreasing mean adherence score value, CHF and CV hospitalization rates were, respectively, 6.7, 9.7, and 14.7% and 11.2, 15.9, and 20.6% (P<0.002 and P<0.001, respectively). Global adherence indicator GAI3 was an independent predictor of time to CV hospitalization in a multi-variable model together with NYHA Class, history of CHF hospitalization, ischaemic aetiology, diabetes mellitus, and hypertension. Conclusion We demonstrate that adherence of physicians to treatment guidelines is a strong predictor of fewer CV hospitalizations in actual practice. There is a need to develop further quality improvement programmes in this condition.</abstract><note type="author-notes">*Corresponding author. Tel: +33 1 4216 3003; fax: +33 1 4216 3020. E-mail address: michel.komajda@psl.ap-hop-paris.fr</note><subject lang="en"><genre>KWD</genre><topic>Guidelines</topic><topic>Chronic heart failure</topic><topic>Care indicators</topic><topic>Outcome</topic></subject><relatedItem type="host"><titleInfo><title>European Heart Journal</title></titleInfo><titleInfo type="abbreviated"><title>Eur Heart J</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">0195-668X</identifier><identifier type="eISSN">1522-9645</identifier><identifier type="PublisherID">eurheartj</identifier><identifier type="PublisherID-hwp">ehj</identifier><identifier type="PublisherID-nlm-ta">Eur Heart J</identifier><part><date>2005</date><detail type="volume"><caption>vol.</caption><number>26</number></detail><detail type="issue"><caption>no.</caption><number>16</number></detail><extent unit="pages"><start>1653</start><end>1659</end></extent></part></relatedItem><identifier type="istex">691076912B713CA68524612817A2BBC2EEE09DCC</identifier><identifier type="DOI">10.1093/eurheartj/ehi251</identifier><identifier type="href">ehi251</identifier><identifier type="local">ehi251</identifier><accessCondition type="use and reproduction" contentType="copyright">© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org</accessCondition><recordInfo><recordContentSource>OUP</recordContentSource></recordInfo></mods></metadata><covers><json:item><original>true</original><mimetype>text/html</mimetype><extension>html</extension><uri>https://api.istex.fr/document/691076912B713CA68524612817A2BBC2EEE09DCC/covers/html</uri></json:item><json:item><original>true</original><mimetype>image/tiff</mimetype><extension>tiff</extension><uri>https://api.istex.fr/document/691076912B713CA68524612817A2BBC2EEE09DCC/covers/tiff</uri></json:item></covers><annexes><json:item><original>true</original><mimetype>image/jpeg</mimetype><extension>jpeg</extension><uri>https://api.istex.fr/document/691076912B713CA68524612817A2BBC2EEE09DCC/annexes/jpeg</uri></json:item><json:item><original>true</original><mimetype>image/gif</mimetype><extension>gif</extension><uri>https://api.istex.fr/document/691076912B713CA68524612817A2BBC2EEE09DCC/annexes/gif</uri></json:item></annexes><enrichments><istex:catWosTEI uri="https://api.istex.fr/document/691076912B713CA68524612817A2BBC2EEE09DCC/enrichments/catWos"><teiHeader><profileDesc><textClass><classCode scheme="WOS">CARDIAC & CARDIOVASCULAR SYSTEMS</classCode></textClass></profileDesc></teiHeader></istex:catWosTEI><json:item><type>refBibs</type><uri>https://api.istex.fr/document/691076912B713CA68524612817A2BBC2EEE09DCC/enrichments/refBibs</uri></json:item></enrichments><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
EXPLOR_STEP=$WICRI_ROOT/Wicri/France/explor/LeHavreV1/Data/Istex/Corpus
HfdSelect -h $EXPLOR_STEP/biblio.hfd -nk 001449 | SxmlIndent | more
Ou
HfdSelect -h $EXPLOR_AREA/Data/Istex/Corpus/biblio.hfd -nk 001449 | SxmlIndent | more
Pour mettre un lien sur cette page dans le réseau Wicri
{{Explor lien
|wiki= Wicri/France
|area= LeHavreV1
|flux= Istex
|étape= Corpus
|type= RBID
|clé= ISTEX:691076912B713CA68524612817A2BBC2EEE09DCC
|texte= Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey
}}
| This area was generated with Dilib version V0.6.25. |  |