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Observational Study
. 2020 Jul;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 Kocabaş  1 , 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
Affiliations
Observational Study

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

Umut Kocabaş et al. Anatol J Cardiol. 2020 Jul.

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.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Cities of participating investigators and centers
Figure 2
Figure 2
Reasons for nonuse of RAS blockers (ACEi, ARBs, and ARNI) in patients with HFrEF RAS - renin angiotensin system; ACEi - angiotensin-converting enzyme inhibitors; ARBs - angiotensin receptor blockers; ARNI - angiotensin receptor–neprilysin inhibitor; HFrEF - heart failure with reduced ejection fraction
Figure 3
Figure 3
Reasons for nonuse of beta-blockers in patients with HFrEF COPD - chronic obstructive pulmonary disease; HFrEF - heart failure with reduced ejection fraction
Figure 4
Figure 4
Reasons for nonuse of MRAs in patients with HFrEF MRAs - mineralocorticoid receptor antagonists; HFrEF - heart failure with reduced ejection fraction
See this image and copyright information in PMC

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