RESUMO
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⯱ 24.6â¯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 (pâ¯< 0.01), 61.9-97.1% for renin-angiotensin system (RAS) inhibitors (pâ¯< 0.01), 29.9-86.8% for mineralocorticoid receptor antagonists (MRAs) (pâ¯< 0.01), 0.0-31.3% for ivabradine (pâ¯< 0.01) and 64.9-100.0% for diuretics (pâ¯< 0.01). Also, the percentage of patients who received the target dose differed significantly, 5.9-29.1% for beta blockers (pâ¯< 0.01), 18.4-56.1% for RAS inhibitors (pâ¯< 0.01) and 13.2-60.6% for MRAs (pâ¯< 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.
RESUMO
BACKGROUND: increasing evidence supports the existence of left ventricular diastolic dysfunction as an important cause of congestive heart failure, present in up to 40% of heart failure patients. AIM: to review the pathophysiology of LV diastolic dysfunction and diastolic heart failure and the currently available methods to diagnose these disorders. RESULTS: for diagnosing LV diastolic dysfunction, invasive hemodynamic measurements are the gold standard. Additional exercise testing with assessment of LV volumes and pressures may be of help in detecting exercise-induced elevation of filling pressures because of diastolic dysfunction. However, echocardiography is obtained more easily, and will remain the most often used method for diagnosing diastolic heart failure in the coming years. MRI may provide noninvasive determination of LV three-dimensional motion during diastole, but data on correlation of MRI data with clinical findings are scant, and possibilities for widespread application are limited at this moment. CONCLUSIONS: in the forthcoming years, optimal diagnostic and therapeutic strategies for patients with primary diastolic heart failure have to be developed. Therefore, future heart failure trials should incorporate patients with diastolic heart failure, describing precise details of LV systolic and diastolic function in their study populations.
