ISSN 2149-2263 | E-ISSN 2149-2271
The Anatolian Journal of Cardiology
Adherence to guideline-directed medical and device Therapy in outpAtients with heart failure with reduced ejection fraction: The ATA study [Anatol J Cardiol]
Anatol J Cardiol. 2020; 24(1): 32-40 | DOI: 10.14744/AnatolJCardiol.2020.91771

Adherence to guideline-directed medical and device Therapy in outpAtients with heart failure with reduced ejection fraction: The ATA study

Umut Kocabaş1, Tarık Kıvrak2, Gülsüm Meral Yılmaz Öztekin3, Veysel Ozan Tanık4, Ibrahim Halil Özdemir5, Ersin Kaya6, Elif Ilkay Yüce7, Fulya Avcı Demir8, Mustafa Doğduş9, Meltem Altınsoy10, Songül Üstündağ11, Ferhat Özyurtlu12, Uğur Karagöz13, Alper Karakuş14, Örsan Deniz Urgun15, Ümit Yaşar Sinan16, Inan Mutlu17, Taner Şen18, Mehmet Ali Astarcıoğlu18, Mustafa Kınık19, Özge Özden Tok20, Begüm Uygur21, Mehtap Yeni22, Bahadır Alan23, Onur Dalgıç24, Çağla Sarıtürk25, Hakan Altay1, Seçkin Pehlivanoğlu1
1Department of Cardiology, Başkent University Istanbul Hospital, Istanbul, Turkey
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

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.

Keywords: adherence, chronic heart failure, device therapy, guidelines, pharmacological treatment, outpatients

Umut Kocabaş, Tarık Kıvrak, Gülsüm Meral Yılmaz Öztekin, Veysel Ozan Tanık, Ibrahim Halil Özdemir, Ersin Kaya, Elif Ilkay Yüce, Fulya Avcı Demir, Mustafa Doğduş, Meltem Altınsoy, Songül Üstündağ, Ferhat Özyurtlu, Uğur Karagöz, Alper Karakuş, Örsan Deniz Urgun, Ümit Yaşar Sinan, Inan Mutlu, Taner Şen, Mehmet Ali Astarcıoğlu, Mustafa Kınık, Özge Özden Tok, Begüm Uygur, Mehtap Yeni, Bahadır Alan, Onur Dalgıç, Çağla Sarıtürk, Hakan Altay, Seçkin Pehlivanoğlu. Adherence to guideline-directed medical and device Therapy in outpAtients with heart failure with reduced ejection fraction: The ATA study. Anatol J Cardiol. 2020; 24(1): 32-40

Corresponding Author: Umut Kocabas, Türkiye
Manuscript Language: English


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