General practitioners' adherence to chronic heart failure guidelines regarding medication: the GP-HF study.

Abstract

The adherence to the guidelines for pharmacotherapy of chronic heart failure (HF)-patients improves prognosis. Although general practitioners (GPs) treat the majority of HF-patients, information about GPs' current guideline adherence and their typical prescription rationales is sparse. A three-stage study design was employed. In Stage I, 206 patient records from 15 randomly chosen GP practices were analysed; 76% of patients were prescribed ACE-inhibitors or angiotensin receptor blockers (ACEIs/ARBs), 73% beta blocker (BBs), but only 18% mineralocorticoid receptor antagonists (MRAs). ACEI doses were at 62% of the guideline recommended target doses, BBs at 46%, while MRAs were sufficiently highly dosed. The guideline adherence indicator (GAI-3) was only 22%. In Stage II, GPs in all 15 practices were interviewed, and health record documentation deficits and patients' contraindications were taken into account. This increased the percentage of patients correctly prescribed ACEIs/ARBs to 87%, BBs to 84% and GAI-3 to 56%. MRAs exhibited the most frequent contraindications, but remained underprescribed. Many GPs seemed not to be aware of the therapeutic value of MRAs or the need to reach target doses of the indicated drug classes. Patients-interviewed in Stage III-reported good tolerability of HF-drugs and generally good compliance, although 11% discontinued HF-medication on their own. Guideline adherence of GPs was higher than expected from literature and might be further improved by highlighting MRAs as the third prognostically relevant drug class beside ACEIs/ARBs and BBs and stronger emphasis on target doses.