TY - JOUR

T1 - Auswirkung einer leitliniengerechten Behandlung auf die Mortalität bei Linksherzinsuffizienz

AU - Neubauer, S.

AU - Schilling, T.

AU - Zeidler, J.

AU - Lange, A.

AU - Engel, S.

AU - Linder, R.

AU - Verheyen, F.

AU - von der Schulenburg, J. M.Graf

AU - Haverich, A.

PY - 2016/11

Y1 - 2016/11

N2 - Background: The German national guidelines on chronic heart failure provide treatment recommendations to physicians and reflect the current level of evidence; however, it is questionable to what extent these recommendations are applied in the routine practice and what the effect of guideline adherence on mortality is. Methods: In this study the claims data of a major German health insurance fund collected over a period of 4 years were analyzed. Using binary logistic regression and Cox regression analyses the influence of drug prescriptions, diagnostic measures, influenza vaccination, the New York Heart Association (NYHA) status, the age and gender on mortality were examined. Results: The study population consisted of 85,465 heart failure patients. Approximately 60 % of the drugs were prescribed according to the guidelines. There was a positive correlation between a higher NYHA status and mortality with an odds ratio (OR) of 3.264. Especially pharmacotherapy with angiotensin-converting enzyme (ACE) inhibitors and beta blockers according to the guidelines was associated with a lower mortality rate (OR 0.448 resp. 0.444). Also patients diagnosed using echocardiography at regular intervals showed a lower risk of dying (OR 0.314). Conclusion: The results of this large sample could confirm the results of clinical trials that a therapy according to the guidelines has a significant impact on mortality. By analyzing the claims data evidence was found that in the treatment of heart failure patients the medical results could be improved by adherence to guideline recommendations.

AB - Background: The German national guidelines on chronic heart failure provide treatment recommendations to physicians and reflect the current level of evidence; however, it is questionable to what extent these recommendations are applied in the routine practice and what the effect of guideline adherence on mortality is. Methods: In this study the claims data of a major German health insurance fund collected over a period of 4 years were analyzed. Using binary logistic regression and Cox regression analyses the influence of drug prescriptions, diagnostic measures, influenza vaccination, the New York Heart Association (NYHA) status, the age and gender on mortality were examined. Results: The study population consisted of 85,465 heart failure patients. Approximately 60 % of the drugs were prescribed according to the guidelines. There was a positive correlation between a higher NYHA status and mortality with an odds ratio (OR) of 3.264. Especially pharmacotherapy with angiotensin-converting enzyme (ACE) inhibitors and beta blockers according to the guidelines was associated with a lower mortality rate (OR 0.448 resp. 0.444). Also patients diagnosed using echocardiography at regular intervals showed a lower risk of dying (OR 0.314). Conclusion: The results of this large sample could confirm the results of clinical trials that a therapy according to the guidelines has a significant impact on mortality. By analyzing the claims data evidence was found that in the treatment of heart failure patients the medical results could be improved by adherence to guideline recommendations.

KW - Claims data

KW - Guideline adherence

KW - Heart failure

KW - Mortality

KW - Pharmacotherapy

UR - http://www.scopus.com/inward/record.url?scp=84958751498&partnerID=8YFLogxK

U2 - 10.1007/s00059-016-4401-0

DO - 10.1007/s00059-016-4401-0

M3 - Artikel

C2 - 26883900

AN - SCOPUS:84958751498

VL - 41

SP - 614

EP - 624

JO - HERZ

JF - HERZ

SN - 0340-9937

IS - 7

ER -