@article{3105897,
    title = "Physicians' guideline adherence is associated with long-term heart failure mortality in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry",
    author = "Komajda, M. and Schöpe, J. and Wagenpfeil, S. and Tavazzi, L. and Böhm, M. and Ponikowski, P. and Anker, S.D. and Filippatos, G.S. and Cowie, M.R. and Aleksanyan, A. and Atayan, L. and Avetisyan, A. and Davtyan, N. and Drambyan, M. and Gevorgyan, K. and Grigoryan, M. and Hakobyan, Z. and Hayrapetyan, H. and Kocharyan, L. and Kramarevskaya, T. and Melqonyan, A. and Muradyan, F. and Nanyan, R. and Ordyan, A. and Ordyan, M. and Piruzyan, A. and Podosyan, G. and Safaryan, K. and Sargsyan, T. and Sarkisyan, A. and Sisakyan, H. and Ter-Grigoryan, V. and Ustyan, T. and Alexopoulos, C. and Amerena, J. and Arstall, M. and Ayres, B. and Barron, G. and Beltrame, J. and Bou-Samra, J. and Brown, M. and Cross, D. and Dwyer, N. and Eccleston, N. and Hare, D. and Ho, B. and Hopper, I. and Jackson, B. and Korczyk, D. and Lattimore, J.D. and Levendel, A. and Macfadyen, R. and Pandeli, V. and Playford, D. and Richardson, M. and Senior, J.A. and Shah, A. and Shetty, P. and Soward, A. and Srivastava, P. and Swale, M. and Vogl, E. and Wai, B. and William, M. and Worthington, A. and Wright, S. and Brunner, B. and Fuhrmann, W. and Horer, L. and Maca, T. and Nahler, A. and Ortner, H. and Racz, G. and Scheibner, P. and Sebald, C. and Abdullayev, A. and Abdullayev, R. and Ahmadov, A. and Alakbarov, E. and Aliyev, F. and Aliyev, F. and Bakhshaliyev, A. and Bakhshiyev, M. and Dadashova, G. and Dashdamirov, R. and Faradjova, N. and Guliyev, A. and Guliyev, F. and Guliyeva, S. and Hajiyev, G. and Ibrahimov, F. and Imanov, G. and Isayeva, A. and Isayeva, M. and Jabrailova, U. and Jafarov, R. and Jahangirov, T. and Khalilov, A. and Khalilov, S. and Mehdiyev, S. and Najafov, R. and Samedova, H. and Shahhuseynov, S. and Yusifly, R. and Yusifov, T. and Zahidova, K. and Zeynalov, A. and Abdullatif, A. and Al-Banna, R. and Haiky, W. and Husain, A. and Jamsheer, A. and Barbuk, O. and Belskaya, M. and Borodko, V. and Kurlianskaya, A. and Mackevich, S. and Mankevich, N. and Moroz-Vodolazhskaya, N. and Ravtovich, O. and Saevich, A. and Troyanova, T. and Chughtai, A. and Johar, S. and Luqman, N. and Nair, T.C.-R. and Deyoung, P. and Ezekowitz, J. and Frenette, M. and Howlett, J. and Huynh, T. and Nguyen, V. and Toma, M. and Orenstein, T. and Rinne, M.R.C. and Virani, S. and Zieroth, S. and Ailiman, M. and Cong, H. and Ding, W. and Dong, W. and Dong, Y. and Gao, C. and Li, L. and Li, Z. and Liang, Y. and Liu, X. and Liu, S. and Luo, S. and Shi, H. and Tian, Q. and Wang, D. and Wang, J. and Wei, M. and Wu, C. and Xu, D. and Yang, X. and Yang, Z. and Zhang, C. and Zhang, Q. and Zhang, Y. and Zhang, R. and Zheng, Y. and Zhao, L. and Zhou, J. and Buch, P. and Davidsen, F. and Eiskjær, H. and Bruun, N.E. and Kragh-Thomsen, N.E. and Franow, H. and Køber, L. and Korup, E. and Madsen, B.K. and Mikkelsen, K. and Nielsen, K.A. and Nørgaard, A. and Refsgaard, J. and Rickers, H. and Kaiser, P. and Sykulski, R. and Zeuthen, E.L. and El Fottoh, A.A. and El Badry, M. and El Hady, Y.A. and El Kady, E. and El Khatib, H. and Fawzy, M. and Hegazy, H. and Salama, M.K. and Mortada, A. and Mostafa, T. and Mwafy, A. and Ossama, M. and Samir, S. and Seleem, M. and Sobhy, B. and Bregadze, G. and Chelidze, K. and Chumburidze, V. and Jalabadze, K. and Khabeishvili, G. and Kiphiani, Z. and Klimiashvili, Z. and Kvitsiani, A. and Mamatsashvili, M. and Melia, I.M.A. and Oragvelidze, T. and Orjonikidze, S. and Paposhvili, K. and Petriashvili, S. and Phaghava, Z. and Shushania, M. and Tsetskhladze, E. and Tsinamdzgvishvili, B. and Abdel-Qader, M. and Al-Zoebi, A. and Böhm, G. and Bosch, R. and Brune, S. and Bunge, K. and Dominick, K. and Duda, S. and Erdogan, A.E. and Faber, G. and Fach, C. and Fechtrup, C. and Frickel, S. and Giokoglu, K. and Haas, J. and Hagenow, A. and Haj-Yehia, A. and Hansen, C. and Hartung, W.M. and Hauser, E.R. and Hofmeister, A. and Hohensee, H. and Hüttemann, M. and Keim, M. and Krämer, A. and Langwasser, K. and Lodde, B.P. and Lorch, G. and Lüer, C. and Müller, K. and Placke, J. and Plesch, B. and Potolidis, L. and Richter, F. and Rieker, W.A. and Schlichting, J. and Stenzel, G. and Theuer, J.D. and Marcin, A. and Warkentin, R. and Wegner, M. and Wilke, A. and Agrafiotis, I. and Aleksandridis, I. and Farmakis, D. and Giannakoulas, G. and Karavidas, A. and Lamprou, A. and Ninios, V. and Panagiotopoulos, K. and Papadopoulos, K. and Siachos, S. and Dékány, M. and Borbéy, A. and Borsányi, T. and Forster, T. and Gavallér, H. and Gyuricza, I. and Heltai, K. and Herczeg, B. and HŐgye, M. and Losonczi, I. and Merkely, B. and Metz, E. and Muk, B. and Nagy, K. and Ökrös, M. and Piry, K. and Poós, G. and Sárszegi, Z. and Somogyi, T. and Sziliczei-Németh, E. and Tátrai, T. and Zima, E. and Zsigmond, A. and Daly, C. and Mahon, N. and Meany, B. and Abbdi, I. and Awaysheh, R. and Azouka, M. and Hamoudeh, S. and Nammas, A. and Okkeh, O. and Aimakova, G. and Ismagulova, Z. and Issabekova, A. and Junusbekova, G.A. and Koshumbayeva, K. and Madaliyev, K. and Mekebekova, D. and Mukatova, A. and Ospanova, G. and Sadvakassova, G. and Sunkarbekova, Z. and Yegorova, Y. and Zhangelova, S. and Kim, K.H. and Al-Mutairi, M. and Gaber, Y. and Ghali, I. and Ghanem, A. and Hafez, H. and Haiba, M. and Koushy, T. and Mahmoud, A. and Raafat, G. and Sallam, M. and Senousi, O. and Soliman, M. and Massih, T.A. and Ali, S.A. and Jaoude, S.A. and Azzi, N. and Badaoui, G. and Bayeh, H. and Beydoun, A. and Chammas, E. and Dib, H. and Gebran, M. and Ghanem, G. and Haidar, H. and Hamadeh, M. and Hamoui, O. and Hobeika, R. and Jazra, C. and Kabbani, S. and Kadri, Z. and Karanaminassian, R. and Kassab, R. and Kleit, M. and Mansour, H. and Mousallem, N. and Semaan, C. and Simonian, A. and Sarkis, A. and Succar, S. and Zalloum, R. and Zind, R. and Anusauskiene, J. and Grigaliuniene, A. and Karaliute, R. and Kavoliuniene, A. and Kozlovaite, V. and Miliuniene, D. and Rinkuniene, D. and Rudys, A. and Stasaityte, D. and Aziz, F.A.A. and Rahim, A.A.A. and Ahmad, R. and Ahmadsah, S.H.K.A. and Ang, C.C. and Ang, S.H. and Cham, Y.L. and Chee, K.H. and Chooi, K.C. and Chu, C.M. and Fam, T.L. and Fong, A. and Ismail, O. and Ismail, J.R. and Kamarulzaman, M.H. and Kasim, S.S. and Khiew, N.Z. and Krishnan, C. and Krishinan, S. and Lau, G. and Lee, L.Y. and Liew, H.B. and Lim, C.W. and Mahendran, K. and Dass, R.D.M. and Mohamad, R. and Arshad, M.K.M. and Unit, H.M. and Mustapha, Z. and Ng, W.K. and Ong, T.K. and Oon, Y.Y. and Ramli, A.W. and Ramanathan, G.R.L. and Ross, N.T. and Said, A. and Sarwar, M. and Tan, E. and Tan, S.K. and Voon, C.Y. and Yusoff, M.R. and Abidin, H.A.Z. and Chua, S.K. and Yew, K.L. and Amin, N.H.M. and Kandiah, K. and Chong, L.A. and Mohamed, M.S. and Lim, B.K. and Koh, K.T. and Low, D.W. and Abdelkhirane, C. and Allali, Y. and Askour, M. and Balafrej, K. and Bendagha, N. and Bendriss, L. and Benjelloun, H. and Chaib, A. and Cherradi, G. and Cherti, M. and Chtioui, M. and El Belghiti, A.R. and Fihri, O.F. and Habbal, R. and El Hattaoui, M. and Khatouri, A. and Kheyi, J. and Kriem, J. and Soufiane, N. and Soufiani, A. and Zaimi, S. and Adamczyk-Kot, D. and Barg, Z. and Bartkowiak, R. and Braciszewicz, W. and Czajkowska, E. and Dudek-Niechciał, M. and Grzelakowski, P. and Jarosik, Z. and Jerzykowska, O. and Koprowski, P. and Krysiak, W. and Łajkowski, Z. and Ziemlewska-Krawczyk, E. and Lelonek, M. and Lewicka, E. and Płonka, J. and Sadowski, J. and StĘpieŃ-Adamczewska, V. and Szponar, J. and WrzesiŃski, K. and Brito, D.A. and Araújo, I. and Figueiredo, J.P.A. and Campelo, M.B. and Sardinha, P.M.B. and Fernando, P. and de Brito Domingues Sanches Peres de Noronha, M.A. and Baptista, S.B.C. and Cardoso Pinto, J.P. and Piçarra, B.M.C. and Farto e Abreu, P. and da Fonseca, M.C.F.G. and Soares, A.I.C.G.O. and Resende, J.D.A. and Durão, D.L. and Nascimento, A.I.F.V. and Bernardes, E.L.M.O. and Marques, F. and Ramos, M.A.N. and Sargento, L.J.M. and dos Santos, J.P.F. and Raimundo, A. and da Luz Ventosa, A.M.S. and Sarmento, P. and Aguiar, C.M.T. and Ahmed, E. and Al-Suwaidi, J. and Al Dabdoob, W. and Badr, A. and Gomaa, M. and Albu, M. and Antohi, I. and Apavaloaei, C. and Ardelean, A. and Badea, G. and Bicescu, G. and Blaj, C. and Bogdan, L. and Bucatanschi, M. and Buzea, A. and Calarasu, V. and Catinean, S. and Christodorescu, R. and Cocoi, D. and Costache, L. and Cretu, D. and Crisu, D. and Dima-Cozma, C. and Dumitrescu, S. and Enache, V. and Firastrau, V. and Frigy, A. and Gherghina, A. and Girbea, S. and Gutu, A. and Horovitz, M. and Hortopan, G. and Istratoaie, O. and Jianu, C. and Jinga, L. and Lighezan, D. and Luka, A. and Magheru, S. and Mercea, D. and Miklos, K. and Moga, R. and Oprea, N. and Paraschiv, D.M. and Pop, D. and Rusu, R. and Sirbu, I. and Socoteanu, E. and Stanciulescu, G. and Suteu, A. and Tetiu, O. and Traistaru, A. and Tudoran, M. and Turiceanu, M.C. and Viinkler, L. and Adonina, E. and Akinina, S. and Alferov, P. and Arkhipov, M. and Aroutunov, G. and Babkin, A. and Barbashina, T. and Bochkareva, J. and Boldueva, S. and Bukhonkina, J. and Chumakova, S.G. and Fayans, I. and Furmenko, G. and Galyavich, A. and Grinstein, Y. and Klein, G. and Kastanayan, A. and Kazachkova, T. and Korolev, S. and Koshelskaya, O. and Kosmacheva, E. and Koziolova, N. and Kuimov, A. and Kushnarenko, N. and Lebedev, P. and Matushin, G. and Mineeva, E. and Motylev, I. and Nedbaykin, A. and Nevzorova, V. and Rachkova, S. and Rebrov, A. and Reznik, I. and Saiganov, S. and Sayfutdinov, R. and Schekotov, V. and Serdechnaya, E. and Shalaev, S. and Shtegman, O. and Sitnikova, M. and Smolenskaya, O. and Sulimov, V. and Tarlovskaya, E. and Temnikova, E. and Timonin, D. and Tolstov, S. and Uskatch, T. and Ustyuzhanin, V. and Valeeva, R. and Vasyuk, Y. and Viktorova, I. and Yakushin, S. and Zadionchenko, V. and Zateischikov, D. and Zhirov, I. and Bollová, D. and Dulková, K. and Fazekaš, F. and Hermel, I. and KŇazeje, M. and NedĚĽová, I. and Nociar, J. and Procházka, L. and Pundová, L. and Slanina, M. and Varga, I. and Almenar, L. and Beltrán, P. and Cobo, M. and Delgado, J. and Enjuanes, C. and Garrido, I. and Gómez, M.A. and Manito, N. and Marzal, D. and Murga, N. and Ocampo, M. and Pérez, J. and Sánchez, I. and Buakhamsri, A. and Leemasawat, K. and Kanoksilp, A. and Kiatchoosakun, S. and Phrommintikul, A. and Porapakkham, P. and Rodprasert, S. and Senthong, V. and Wongcharoen, W. and Wongwantanee, S. and Bahadir, H. and Emül, A. and Gokce, M. and Gurcagan, A. and Kaya, O.K. and Keser, A. and Pinar, P. and Taș, M.H. and Tosun, H.B. and Yazlar, A.S. and Yilmaz, S. and Yuksel, Y. and Bagriy, A. and Ivchyna, N. and Lyashenko, A. and Matviychuk, N. and Shchukina, O. and Tkach, N. and Tseluyko, V. and Vasylieva, L. and Abdallah, A. and Agrawal, A. and Basleeb, F. and Bazargani, N. and Hatou, E. and Al Kaddour, A.R. and Al Kasser, M. and Al Mulla, A. and Radaideh, G. and Salustri, A. and on behalf of the QUALIFY Investigators",
    journal = "European Journal of Heart Failure",
    year = "2019",
    volume = "21",
    number = "7",
    pages = "921-929",
    publisher = "John Wiley and Sons Ltd",
    doi = "10.1002/ejhf.1459",
    keywords = "angiotensin receptor antagonist;  beta adrenergic receptor blocking agent;  dipeptidyl carboxypeptidase inhibitor;  ivabradine;  mineralocorticoid antagonist;  cardiovascular agent, adult;  Article;  cardiovascular mortality;  female;  heart failure with reduced ejection fraction;  hospitalization;  human;  longitudinal study;  major clinical study;  male;  New York Heart Association class;  observational study;  outpatient care;  priority journal;  prospective study;  protocol compliance;  classification;  clinical practice;  follow up;  heart failure;  heart stroke volume;  medication therapy management;  middle aged;  mortality;  outpatient;  pathophysiology;  practice guideline;  protocol compliance;  register;  total quality management, Cardiovascular Agents;  Female;  Follow-Up Studies;  Guideline Adherence;  Heart Failure;  Hospitalization;  Humans;  Male;  Medication Therapy Management;  Middle Aged;  Outcome Assessment, Health Care;  Outpatients;  Practice Guidelines as Topic;  Practice Patterns, Physicians';  Quality Improvement;  Registries;  Stroke Volume",
    abstract = "Background: Physicians' adherence to guideline-recommended therapy is associated with short-term clinical outcomes in heart failure (HF) with reduced ejection fraction (HFrEF). However, its impact on longer-term outcomes is poorly documented. Here, we present results from the 18-month follow-up of the QUALIFY registry. Methods and results: Data at 18 months were available for 6118 ambulatory HFrEF patients from this international prospective observational survey. Adherence was measured as a continuous variable, ranging from 0 to 1, and was assessed for five classes of recommended HF medications and dosages. Most deaths were cardiovascular (CV) (228/394) and HF-related (191/394) and the same was true for unplanned hospitalizations (1175 CV and 861 HF-related hospitalizations, out of a total of 1541). According to univariable analysis, CV and HF deaths were significantly associated with physician adherence to guidelines. In multivariable analysis, HF death was associated with adherence level [subdistribution hazard ratio (SHR) 0.93, 95% confidence interval (CI) 0.87–0.99 per 0.1 unit adherence level increase; P = 0.034] as was composite of HF hospitalization or CV death (SHR 0.97, 95% CI 0.94–0.99 per 0.1 unit adherence level increase; P = 0.043), whereas unplanned all-cause, CV or HF hospitalizations were not (all-cause: SHR 0.99, 95% CI 0.9–1.02; CV: SHR 0.98, 95% CI 0.96–1.01; and HF: SHR 0.99, 95% CI 0.96–1.02 per 0.1 unit change in adherence score; P = 0.52, P = 0.2, and P = 0.4, respectively). Conclusion: These results suggest that physicians' adherence to guideline-recommended HF therapies is associated with improved outcomes in HFrEF. Practical strategies should be established to improve physicians' adherence to guidelines. © 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology"
}