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

Byung Su Yoo, Jaewon Oh, Bum Kee Hong, Dae Hee Shin, Jang Ho Bae, Dong Heon Yang, Wan Joo Shim, Hyung Seop Kim, Su Hong Kim, Jin Oh Choi, Woo Jung Chun, Choong Won Go, Hyun Jae Kang, Sang Hong Baek, Jang Hyun Cho, Suk Keun Hong, Joon Han Shin, Seok Kyu Oh, Wook Bum Pyun, Jun KwanYoung Joon Hong, Jin Ok Jeong, Seok Min Kang, Dong Ju Choi

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22 Citations (Scopus)

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.

Original languageEnglish
Article numbere86596
JournalPloS one
Volume9
Issue number1
DOIs
Publication statusPublished - 2014 Jan 27

Bibliographical note

Funding Information:
This study was supported by a grant of GlaxoSmithKline Korea. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. This funding does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials. Every author declared their commercial declaration using ICMJE form for disclosure of potential conflicts of interest. The authors attached two ICMJE forms (pdf file) of first and corresponding author as representative.

All Science Journal Classification (ASJC) codes

  • General

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