Background: Adherence to pharmacotherapeutic treatment guidelines in patients with heart failure (HF) is of major
prognostic importance, but thorough implementation of guidelines in routine care remains insufficient. Our aim
was to investigate prevalence and characteristics of HF in patients with coronary heart disease (CHD), and to assess
the adherence to current HF guidelines in patients with HF stage C, thus identifying potential targets for the
optimization of guideline implementation.
Methods: Patients from the German sample of the European Action on Secondary and Primary Prevention by
Intervention to Reduce Events (EuroAspire) IV survey with a hospitalization for CHD within the previous six to
36 months providing valid data on echocardiography as well as on signs and symptoms of HF were categorized
into stages of HF: A, prevalence of risk factors for developing HF; B, asymptomatic but with structural heart disease;
C, symptomatic HF. A Guideline Adherence Indicator (GAI-3) was calculated for patients with reduced (≤40%) left
ventricular ejection fraction (HFrEF) as number of drugs taken per number of drugs indicated; beta-blockers,
angiotensin converting enzyme inhibitors/angiotensin receptor blockers, and mineralocorticoid receptor antagonists
(MRA) were considered.
Results: 509/536 patients entered analysis. HF stage A was prevalent in n = 20 (3.9%), stage B in n = 264 (51.9%),
and stage C in n = 225 (44.2%) patients; 94/225 patients were diagnosed with HFrEF (42%). Stage C patients were
older, had a longer duration of CHD, and a higher prevalence of arterial hypertension. Awareness of pre-diagnosed
HF was low (19%). Overall GAI-3 of HFrEF patients was 96.4% with a trend towards lower GAI-3 in patients with
lower LVEF due to less thorough MRA prescription.
Conclusions: In our sample of CHD patients, prevalence of HF stage C was high and a sizable subgroup suffered
from HFrEF. Overall, pharmacotherapy was fairly well implemented in HFrEF patients, although somewhat worse in
patients with more reduced ejection fraction. Two major targets were identified possibly suited to further improve
the implementation of HF guidelines: 1) increase patients´ awareness of diagnosis and importance of HF; and 2)
disseminate knowledge about the importance of appropriately implementing the use of mineralocorticoid receptor
antagonists