, Tarık Kıvrak 2
, Gülsüm Meral Yılmaz Öztekin 3
, Veysel Ozan Tanık 4
, Ibrahim Halil Özdemir 5
, Ersin Kaya 6
, Elif Ilkay Yüce 7
, Fulya Avcı Demir 8
, Mustafa Doğduş 9
, Meltem Altınsoy 10
, Songül Üstündağ 11
, Ferhat Özyurtlu 12
, Uğur Karagöz 13
, Alper Karakuş 14
, Örsan Deniz Urgun 15
, Ümit Yaşar Sinan 16
, Inan Mutlu 17
, Taner Şen 18
, Mehmet Ali Astarcıoğlu 18
, Mustafa Kınık 19
, Özge Özden Tok 20
, Begüm Uygur 21
, Mehtap Yeni 22
, Bahadır Alan 23
, Onur Dalgıç 24
, Çağla Sarıtürk 25
, Hakan Altay 1
, Seçkin Pehlivanoğlu 1
2Department of Cardiology, Firat University, School of Medicine Hospital, Elazığ, Turkey
3Department of Cardiology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
4Department of Cardiology, University of Health Sciences Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
5Department of Cardiology, Nizip State Hospital, Gaziantep, Turkey
6Department of Cardiology, University of Health Sciences Dr Suat Seren Chest Diseases and Chest Surgery Training and Research Hospital, Izmir, Turkey
7Department of Cardiology, Kelkit State Hospital, Gümüşhane, Turkey
8Department of Cardiology, Elmalı State Hospital, Antalya, Turkey
9Department of Cardiology, Karaman State Hospital, Karaman, Turkey
10Department of Cardiology, University of Health Sciences Ankara Atatürk Chest Diseases and Chest Surgery Training and Research Hospital, Ankara, Turkey
11Department of Cardiology, Erzincan Binali Yıldırım University, Mengücek Gazi Educatıon and Research Hospital, Erzincan, Turkey
12Department of Cardiology, Grandmedical Hospital, Manisa, Turkey
13Department of Cardiology, Izmir Katip Celebi University Atatürk Education and Research Hospital, Izmir, Turkey
14Department of Cardiology, Besni State Hospital, Adıyaman, Turkey
15Department of Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey
16Department of Cardiology, Faculty of Medicine, Istanbul University, Institute of Cardiology, Istanbul,Turkey
17Department of Cardiology, University of Health Sciences Tepecik Training and Research Hospital, Izmir, Turkey
18Department of Cardiology, Kütahya Health Sciences University, School of Medicine, Kütahya, Turkey
19Department of Cardiology, Recep Tayyip Erdoğan University Training and Research Hospital, Rize, Turkey
20Department of Cardiology, Memorial Hospital, Istanbul, Turkey
21Department of Cardiology, University Of Health Sciences Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
22Department of Cardiology, Isparta State Hospital, Isparta, Turkey.
23Department of Cardiology, Okan University, School of Medicine, Istanbul, Turkey.
24Department of Cardiology, Life Park Hospital, Sivas, Turkey.
25Department of Biostatistics, Başkent University Adana Hospital, Adana, Turkey
Abstract
Objective: Despite recommendations from heart failure guidelines on the use of pharmacologic and device therapy in patients with heart failure with reduced ejection fraction (HFrEF), important inconsistencies in guideline adherence persist in practice. The aim of this study was to assess adherence to guideline-directed medical and device therapy for the treatment of patients with chronic HFrEF (left ventricular ejection fraction ≤40%).
Methods: The Adherence to guideline-directed medical and device Therapy in outpAtients with HFrEF (ATA) study is a prospective, multicenter, observational study conducted in 24 centers from January 2019 to June 2019.
Results: The study included 1462 outpatients (male: 70.1%, mean age: 67±11 years, mean LVEF: 30%±6%) with chronic HFrEF. Renin–angiotensin system (RAS) inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRAs), and ivabradin were used in 78.2%, 90.2%, 55.4%, and 12.1% of patients, respectively. The proportion of patients receiving target doses of medical treatments was 24.6% for RAS inhibitors, 9.9% for beta-blockers, and 10.5% for MRAs. Among patients who met the criteria for implantable cardioverter–defibrillator (ICD) and cardiac resynchronization therapy (CRT), only 16.9% of patients received an ICD (167 of 983) and 34% (95 of 279) of patients underwent CRT (95 of 279).
Conclusion: The ATA study shows that most HFrEF outpatients receive RAS inhibitors and beta-blockers but not MRAs or ivabradin when the medical reasons for nonuse, such as drug intolerance or contraindications, are taken into account. In addition, most eligible patients with HFrEF do not receive target doses of pharmacological treatments or guideline-recommended device therapy.