Pharmacotherapy according to treatment guidelines is associated with lower mortality in a community-based sample of patients with chronic heart failure A prospective cohort study

Background: The effectiveness of chronic heart failure (CHF) pharmacotherapy in unselected cohorts is unknown. Aims: To estimate the association between quality of CHF pharmacotherapy and all-cause mortality risk. Methods and results: In a prospective cohort study, 1054 unselected patients with CHF (61% with reduced and 39% with normal left ventricular ejection fraction (LVEF)) were consecutively enrolled. Quality of pharmacotherapy was assessed by calculating a guideline adherence indicator (GAI-3, range 0-100%) based on prescription of beta blockers, angiotensin converting enzyme inhibitors or angiotensin receptor 11 type-1 blockers, and mineralocorticoid receptor antagonists. Median follow-up in survivors was 595 days (100% complete). In patients with reduced LVEF the median GAI-3 was 67%, and inversely associated with age, Cl-IF severity, and important comorbidities. Mortality rates in GAI-3 categories low/medium/high were 79/30/11 per 100 person-years. In multivariable Cox regression, high GAI-3 was independently predictive of lower mortality risk: hazard ratio (HR) 0.50 (95% confidence interval [CI] 0.32-0.74; P < 0.001) vs low GAI-3. This association was also observed in subgroups of high age (HR 0.42, 95%CI 0.27-0.66; P < 0.001) and women (HR 0.42, 95%CI 0.23-0.79; P = 0.007). Conclusions: In this community-based cohort with CHF, better implementation of pharmacotherapy was associated with better prognosis in patients with reduced LVEF, irrespective of age and sex. (C) 2008 Published by Elsevier B.V on behalf of European Society of Cardiology.