TY  - JOUR
A1  - Morbach, Caroline
A1  - Wagner, Martin
A1  - Güntner, Stefan
A1  - Malsch, Carolin
A1  - Oezkur, Mehmet
A1  - Wood, David
A1  - Kotseva, Kornelia
A1  - Leyh, Rainer
A1  - Ertl, Georg
A1  - Karmann, Wolfgang
A1  - Heuschmann, Peter U
A1  - Störk, Stefan
T1  - Heart failure in patients with coronary heart disease: Prevalence, characteristics and guideline implementation - Results from the German EuroAspire IV cohort
T2  - BMC Cardiovascular Disorders
N2  - Background:
Adherence to pharmacotherapeutic treatment guidelines in patients with heart failure (HF) is of major prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Our aim was to investigate prevalence and characteristics of HF in patients with coronary heart disease (CHD), and to assess the adherence to current HF guidelines in patients with HF stage C, thus identifying potential targets for the optimization of guideline implementation.
Methods:
Patients from the German sample of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EuroAspire) IV survey with a hospitalization for CHD within the previous six to 36 months providing valid data on echocardiography as well as on signs and symptoms of HF were categorized into stages of HF: A, prevalence of risk factors for developing HF; B, asymptomatic but with structural heart disease; C, symptomatic HF. A Guideline Adherence Indicator (GAI-3) was calculated for patients with reduced (≤40%) left ventricular ejection fraction (HFrEF) as number of drugs taken per number of drugs indicated; beta-blockers, angiotensin converting enzyme inhibitors/angiotensin receptor blockers, and mineralocorticoid receptor antagonists (MRA) were considered.
Results:
509/536 patients entered analysis. HF stage A was prevalent in n = 20 (3.9%), stage B in n = 264 (51.9%), and stage C in n = 225 (44.2%) patients; 94/225 patients were diagnosed with HFrEF (42%). Stage C patients were older, had a longer duration of CHD, and a higher prevalence of arterial hypertension. Awareness of pre-diagnosed HF was low (19%). Overall GAI-3 of HFrEF patients was 96.4% with a trend towards lower GAI-3 in patients with lower LVEF due to less thorough MRA prescription.
Conclusions:
In our sample of CHD patients, prevalence of HF stage C was high and a sizable subgroup suffered from HFrEF. Overall, pharmacotherapy was fairly well implemented in HFrEF patients, although somewhat worse in patients with more reduced ejection fraction. Two major targets were identified possibly suited to further improve the implementation of HF guidelines: 1) increase patients´ awareness of diagnosis and importance of HF; and 2) disseminate knowledge about the importance of appropriately implementing the use of mineralocorticoid receptor antagonists.
Trial registration: 
This is a cross-sectional analysis of a non-interventional study. Therefore, it was not registered as an interventional trial.
KW  - awareness
KW  - heart failure
KW  - pharmacotherapy
KW  - coronary artery disease
KW  - coronary heart disease
KW  - euroaspire
KW  - guideline adherence
KW  - guideline implementation
KW  - mineralocorticoid antagonist
KW  - preserved ejection fraction
Y1  - 2017
UR  - https://opus.bibliothek.uni-wuerzburg.de/frontdoor/index/index/docId/15773
UR  - https://nbn-resolving.org/urn:nbn:de:bvb:20-opus-157738
VL  - 17
IS  - 108
ER  -