Dose matters! Optimisation of guideline adherence is associated with lower mortality in stable patients with chronic heart failure

Austrian Working Group on Heart Failure, M Wieser, A Boehmer

Research output: Journal article (peer-reviewed)Journal article

54 Citations (Scopus)


AIMS: Guidelines have been published for improving management of chronic heart failure (CHF). We examined the association between improved guideline adherence and risk for all-cause death in patients with stable systolic HF.

METHODS: Data on ambulatory patients (2006-2010) with CHF and reduced ejection fraction (HF-REF) from the Austrian Heart Failure Registry (HIR Austria) were analysed. One-year clinical data and long-term follow-up data until all-cause death or data censoring were available for 1014 patients (age 65 [55-73], male 75%, NYHA class I 14%, NYHA II 56%, NYHA III/IV 30%). A guideline adherence indicator (GAI [0-100%]) was calculated for each patient at baseline and after 12 ± 3 months that considered indications and contraindications for ACE-I/ARB, beta blockers, and MRA. Patients were considered ΔGAI-positive if GAI improved to or remained at high levels (≥ 80%). ΔGAI50+ positivity was ascribed to patients achieving a dose of ≥ 50% of suggested target dose.

RESULTS: Improvements in GAI and GAI50+ were associated with significant improvements in NYHA class and NT-proBNP (1728 [740-3636] to 970 [405-2348]) (p<0.001). Improvements in GAI50+, but not GAI, were independently predictive of lower mortality risk (HR 0.55 [95% CI 0.34-0.87; p=0.01]) after adjustment for a large variety of baseline parameters and hospitalisation for heart failure during follow-up.

CONCLUSIONS: Improvement in guideline adherence with particular emphasis on dose escalation is associated with a decrease in long-term mortality in ambulatory HF-REF subjects surviving one year after registration.

Original languageEnglish
Pages (from-to)83-89
Number of pages7
JournalInternational Journal of Cardiology
Issue number1
Publication statusPublished - 15 Jul 2014


  • Aged
  • Australia/epidemiology
  • Cardiovascular Agents/administration & dosage
  • Chronic Disease
  • Female
  • Follow-Up Studies
  • Guideline Adherence/trends
  • Heart Failure/diagnosis
  • Humans
  • Male
  • Medication Adherence
  • Middle Aged
  • Mortality/trends
  • Registries
  • Prognosis
  • Guideline adherence indicator
  • Chronic heart failure
  • Treatment adjustment

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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