Differences in guideline-recommended heart failure medication between Dutch heart failure clinics: an analysis of the CHECK-HF registry

G.C.M. Linssen; J.F. Veenis; H.P. Brunner-La Rocca; P.E.J. van Pol; D.J.M. Engelen; R.M. van Tooren; H.J.J. Koornstra-Wortel; A.W. Hoes; J.J. Brugts; CHECK-HF Investigators

doi:10.1007/s12471-020-01421-1

Differences in guideline-recommended heart failure medication between Dutch heart failure clinics: an analysis of the CHECK-HF registry

G.C.M. Linssen^*, J.F. Veenis, H.P. Brunner-La Rocca, P.E.J. van Pol, D.J.M. Engelen, R.M. van Tooren, H.J.J. Koornstra-Wortel, A.W. Hoes, J.J. Brugts, CHECK-HF Investigators

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

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 & x202f;+/- 11.8 years (ranging between 69.1 & x202f;+/- 11.9 and 76.6 & x202f;+/- 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 & x202f;+/- 24.6 & x202f;ml/min (ranging between 45.7 & x202f;+/- 23.5 and 97.1 & x202f;+/- 16.5). The prescription rates ranged from 58.9-97.4% for beta blockers (p & x202f;< 0.01), 61.9-97.1% for renin-angiotensin system (RAS) inhibitors (p & x202f;< 0.01), 29.9-86.8% for mineralocorticoid receptor antagonists (MRAs) (p & x202f;< 0.01), 0.0-31.3% for ivabradine (p & x202f;< 0.01) and 64.9-100.0% for diuretics (p & x202f;< 0.01). Also, the percentage of patients who received the target dose differed significantly, 5.9-29.1% for beta blockers (p & x202f;< 0.01), 18.4-56.1% for RAS inhibitors (p & x202f;< 0.01) and 13.2-60.6% for MRAs (p & x202f;< 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.

Original language	English
Pages (from-to)	334-344
Number of pages	11
Journal	Netherlands Heart Journal
Volume	28
Issue number	6
DOIs	https://doi.org/10.1007/s12471-020-01421-1
Publication status	Published - 1 Jun 2020

Keywords

adherence
elderly-patients
guidelines
heart failure
hfmref
hfref
medication
reduced ejection fraction
therapy
Heart failure
HFrEF
HFmrEF
Guidelines
Adherence
REDUCED EJECTION FRACTION
THERAPY
Medication
ELDERLY-PATIENTS

Access to Document

10.1007/s12471-020-01421-1Licence: CC BY

Cite this

Linssen, G. C. M., Veenis, J. F., Brunner-La Rocca, H. P., van Pol, P. E. J., Engelen, D. J. M., van Tooren, R. M., Koornstra-Wortel, H. J. J., Hoes, A. W., Brugts, J. J., & CHECK-HF Investigators (2020). Differences in guideline-recommended heart failure medication between Dutch heart failure clinics: an analysis of the CHECK-HF registry. Netherlands Heart Journal, 28(6), 334-344. https://doi.org/10.1007/s12471-020-01421-1

@article{9a8a6a15f74843538c72d00cb0d56fae,

title = "Differences in guideline-recommended heart failure medication between Dutch heart failure clinics: an analysis of the CHECK-HF registry",

abstract = "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 & x202f;+/- 11.8 years (ranging between 69.1 & x202f;+/- 11.9 and 76.6 & x202f;+/- 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 & x202f;+/- 24.6 & x202f;ml/min (ranging between 45.7 & x202f;+/- 23.5 and 97.1 & x202f;+/- 16.5). The prescription rates ranged from 58.9-97.4% for beta blockers (p & x202f;< 0.01), 61.9-97.1% for renin-angiotensin system (RAS) inhibitors (p & x202f;< 0.01), 29.9-86.8% for mineralocorticoid receptor antagonists (MRAs) (p & x202f;< 0.01), 0.0-31.3% for ivabradine (p & x202f;< 0.01) and 64.9-100.0% for diuretics (p & x202f;< 0.01). Also, the percentage of patients who received the target dose differed significantly, 5.9-29.1% for beta blockers (p & x202f;< 0.01), 18.4-56.1% for RAS inhibitors (p & x202f;< 0.01) and 13.2-60.6% for MRAs (p & x202f;< 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.",

keywords = "adherence, elderly-patients, guidelines, heart failure, hfmref, hfref, medication, reduced ejection fraction, therapy, Heart failure, HFrEF, HFmrEF, Guidelines, Adherence, REDUCED EJECTION FRACTION, THERAPY, Medication, ELDERLY-PATIENTS",

author = "G.C.M. Linssen and J.F. Veenis and {Brunner-La Rocca}, H.P. and {van Pol}, P.E.J. and D.J.M. Engelen and {van Tooren}, R.M. and H.J.J. Koornstra-Wortel and A.W. Hoes and J.J. Brugts and {CHECK-HF Investigators}",

note = "Funding Information: H.P. Brunner-La Rocca has received research grants from Roche Diagnostics, Novartis, and Vifor. G.C.M. Linssen, J.F. Veenis, P.E.J. van Pol, D.J.M. Engelen, R.M. van Tooren, H.J.J. Koornstra-Wortel, A.W. Hoes and J.J. Brugts declare that they have no competing interests. Funding Information: This work was supported by Servier, the Netherlands, who unrestrictedly funded the inclusion of data and software program. The steering committee (JB, GL, AH, HBRLR) received no funding for this project. Funding Information: We greatly acknowledge the participation of heart failure nurses and cardiologists of all participating sites for including patients and entering patient data. We also acknowledge the work of Rik van de Kamp (Servier Pharma, the Netherlands) for the development of the software program. All authors contributed to the analysis of the data and writing of the report. All authors approved the final version of the manuscript. This work was supported by Servier, the Netherlands, who unrestrictedly funded the inclusion of data and software program. The steering committee (JB, GL, AH, HBRLR) received no funding for this project. Publisher Copyright: {\textcopyright} 2020, The Author(s).",

year = "2020",

month = jun,

day = "1",

doi = "10.1007/s12471-020-01421-1",

language = "English",

volume = "28",

pages = "334--344",

journal = "Netherlands Heart Journal",

issn = "1568-5888",

publisher = "Bohn Stafleu van Loghum",

number = "6",

}

Linssen, GCM, Veenis, JF, Brunner-La Rocca, HP, van Pol, PEJ, Engelen, DJM, van Tooren, RM, Koornstra-Wortel, HJJ, Hoes, AW, Brugts, JJ & CHECK-HF Investigators 2020, 'Differences in guideline-recommended heart failure medication between Dutch heart failure clinics: an analysis of the CHECK-HF registry', Netherlands Heart Journal, vol. 28, no. 6, pp. 334-344. https://doi.org/10.1007/s12471-020-01421-1

TY - JOUR

T1 - Differences in guideline-recommended heart failure medication between Dutch heart failure clinics: an analysis of the CHECK-HF registry

AU - Linssen, G.C.M.

AU - Veenis, J.F.

AU - Brunner-La Rocca, H.P.

AU - van Pol, P.E.J.

AU - Engelen, D.J.M.

AU - van Tooren, R.M.

AU - Koornstra-Wortel, H.J.J.

AU - Hoes, A.W.

AU - Brugts, J.J.

AU - CHECK-HF Investigators

N1 - Funding Information: H.P. Brunner-La Rocca has received research grants from Roche Diagnostics, Novartis, and Vifor. G.C.M. Linssen, J.F. Veenis, P.E.J. van Pol, D.J.M. Engelen, R.M. van Tooren, H.J.J. Koornstra-Wortel, A.W. Hoes and J.J. Brugts declare that they have no competing interests. Funding Information: This work was supported by Servier, the Netherlands, who unrestrictedly funded the inclusion of data and software program. The steering committee (JB, GL, AH, HBRLR) received no funding for this project. Funding Information: We greatly acknowledge the participation of heart failure nurses and cardiologists of all participating sites for including patients and entering patient data. We also acknowledge the work of Rik van de Kamp (Servier Pharma, the Netherlands) for the development of the software program. All authors contributed to the analysis of the data and writing of the report. All authors approved the final version of the manuscript. This work was supported by Servier, the Netherlands, who unrestrictedly funded the inclusion of data and software program. The steering committee (JB, GL, AH, HBRLR) received no funding for this project. Publisher Copyright: © 2020, The Author(s).

PY - 2020/6/1

Y1 - 2020/6/1

N2 - 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 & x202f;+/- 11.8 years (ranging between 69.1 & x202f;+/- 11.9 and 76.6 & x202f;+/- 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 & x202f;+/- 24.6 & x202f;ml/min (ranging between 45.7 & x202f;+/- 23.5 and 97.1 & x202f;+/- 16.5). The prescription rates ranged from 58.9-97.4% for beta blockers (p & x202f;< 0.01), 61.9-97.1% for renin-angiotensin system (RAS) inhibitors (p & x202f;< 0.01), 29.9-86.8% for mineralocorticoid receptor antagonists (MRAs) (p & x202f;< 0.01), 0.0-31.3% for ivabradine (p & x202f;< 0.01) and 64.9-100.0% for diuretics (p & x202f;< 0.01). Also, the percentage of patients who received the target dose differed significantly, 5.9-29.1% for beta blockers (p & x202f;< 0.01), 18.4-56.1% for RAS inhibitors (p & x202f;< 0.01) and 13.2-60.6% for MRAs (p & x202f;< 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.

AB - 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 & x202f;+/- 11.8 years (ranging between 69.1 & x202f;+/- 11.9 and 76.6 & x202f;+/- 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 & x202f;+/- 24.6 & x202f;ml/min (ranging between 45.7 & x202f;+/- 23.5 and 97.1 & x202f;+/- 16.5). The prescription rates ranged from 58.9-97.4% for beta blockers (p & x202f;< 0.01), 61.9-97.1% for renin-angiotensin system (RAS) inhibitors (p & x202f;< 0.01), 29.9-86.8% for mineralocorticoid receptor antagonists (MRAs) (p & x202f;< 0.01), 0.0-31.3% for ivabradine (p & x202f;< 0.01) and 64.9-100.0% for diuretics (p & x202f;< 0.01). Also, the percentage of patients who received the target dose differed significantly, 5.9-29.1% for beta blockers (p & x202f;< 0.01), 18.4-56.1% for RAS inhibitors (p & x202f;< 0.01) and 13.2-60.6% for MRAs (p & x202f;< 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.

KW - adherence

KW - elderly-patients

KW - guidelines

KW - heart failure

KW - hfmref

KW - hfref

KW - medication

KW - reduced ejection fraction

KW - therapy

KW - Heart failure

KW - HFrEF

KW - HFmrEF

KW - Guidelines

KW - Adherence

KW - REDUCED EJECTION FRACTION

KW - THERAPY

KW - Medication

KW - ELDERLY-PATIENTS

U2 - 10.1007/s12471-020-01421-1

DO - 10.1007/s12471-020-01421-1

M3 - Article

C2 - 32430655

SN - 1568-5888

VL - 28

SP - 334

EP - 344

JO - Netherlands Heart Journal

JF - Netherlands Heart Journal

IS - 6

ER -