Patients in the MAHLER study[4] were aged 40 or over, with an average age of nearly 69. They were followed up for six months. The researchers found that while adherence to diagnosis guidelines was high at 74%, adherence to treatment guidelines was much lower, with large variations between the five different treatments; 85% of patients who needed them were prescribed ACE-inhibitors, 58% were given beta-blockers, 83% a diuretic agent, 52% a cardiac glycoside, and only 36% spironolactone.

When the researchers looked at the impact on outcome of the "big three" drugs (ACE-inhibitors, beta-blockers and spironolactone) they found that amongst patients who were treated with perfect adherence to the guidelines 6.7% and 11.2% were admitted to hospital with chronic heart failure (CHF) or a worsening of their cardiovascular (CV) symptoms respectively; this compared with figures of 9.7% and 15.9% respectively for moderate adherence and 14.7% and 20.6% for low adherence. These outcomes were independent of the severity of the disease, previous hospitalizations for CHF, or the presence of high blood pressure or diabetes.

"We found that adherence to treatment guidelines was independently and strongly correlated to outcome measured by rate of CHF or CV hospitalization and time to CV hospitalization," said Prof Komajda.

"We hope that these results will encourage cardiologists to ensure that they are familiar with, and adhere to, treatment guidelines. Integrated approaches, including nurses, dieticians, generalists and cardiologists, are needed in order to improve the management of chronic heart failure in clinical practice."

The researchers found there was plenty of room for improvement in the treatment of patients with heart failure. "Prescription of beta-blockers was observed in only half of the patients who should be receiving them, according to ESC guid
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Contact: Emma Mason
wordmason@mac.com
44-1-376-563-090
European Society of Cardiology
2-May-2005