Adherence to the guidelines on the management of systolic heart failure in ambulatory care in Poland. Data from the international QUALIFY survey

INTRODUCTION    Adherence to guidelines is associated with improved patient prognosis.
OBJECTIVES    The aim of this study was to evaluate adherence to guidelines on the management of heart failure (HF) in ambulatory care in Poland.
PATIENTS AND METHODS    The study included 209 outpatients with HF who participated in the prospective, observational QUALIFY survey. The inclusion criteria were as follows: age of 18 years or older, systolic HF with left ventricular ejection fraction of 40% or lower, and hospitalization for HF exacerbation within the previous 1 to 15 months. We assessed prescription of medications for HF and dose selection (classified as a target dose or as 50% or more of the target dose). The adherence score was calculated on the basis of the use of angiotensin‑converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β‑blockers, mineralocorticoid receptor antagonists (MRAs), and ivabradine. The use of all indicated medications was scored as good adherence; of more than half of the medications, as moderate adherence; and of half of the medications or fewer, as poor adherence. 
RESULTS    The mean (SD) age of the patients was 67.4 (10.9) years; men constituted 77.0% of the population. Almost 92.0% of the patients were prescribed ACEIs or ARBs, of whom only 27.4% and 4.0%, respectively, reached the target doses. Nearly 97.0% of the patients received β‑blockers, with only 17.7% reaching the target dose. MRAs were prescribed in 73.2% of the patients, of whom 66.0% reached the target dose. Ivabradine was prescribed in 13.9% of the patients, but the target dose was attained only in 13.8%. The adherence was good in 72.2%, moderate in 23.9%, and poor in 3.8% of the study population.
CONCLUSIONS    Most patients with HF in Poland receive adequate treatment, but the proportion of patients reaching the target doses is suboptimal.