SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real World (SUGAR): a multi-center, retrospective, observational study

Abstract

BACKGROUND: Clinical practice guidelines have been slowly and inconsistently

applied in clinical practice, and certain evidence-based, guideline-driven

therapies for heart failure (HF) have been significantly underused. The purpose

of this study was to survey guideline compliance and its effect on clinical

outcomes in the treatment of systolic HF in Korea. METHOD AND RESULTS: The SUrvey

of Guideline Adherence for Treatment of Systolic Heart Failure in Real World

(SUGAR) trial was a multi-center, retrospective, observational study on subjects

with systolic HF (ejection fraction <45%) admitted to 23 university hospitals.

The guideline adherence indicator (GAI) was defined as a performance measure on

the basis of 3 pharmacological classes: angiotensin-converting enzyme inhibitor

(ACEI) or angiotensin receptor II blocker (ARB), beta-blocker (BB), and

aldosterone antagonist (AA). Based on the overall adherence percentage, subjects

were divided into 2 groups: those with good guideline adherence (GAI >/=50%) and

poor guideline adherence (GAI <50%). We included 1319 regional participants as

representatives of the standard population from the Korean national census in

2008. Adherence to drugs at discharge was as follows: ACEI or ARB, 89.7%; BB,

69.2%; and AA, 65.9%. Overall, 82.7% of the patients had good guideline

adherence. Overall mortality and re-hospitalization rates at 1 year were 6.2% and

37.4%, respectively. Survival analysis by log-rank test showed a significant

difference in event-free survival rate of mortality (94.7% vs. 89.8%, p = 0.003)

and re-hospitalization (62.3% vs. 56.4%, p = 0.041) between the good and poor

guideline-adherence groups. CONCLUSIONS: Among patients with systolic HF in

Korea, adherence to pharmacologic treatment guidelines as determined by

performance measures, including prescription of ACEI/ARB and BB at discharge, was

associated with improved clinical outcomes.