Umsetzung der leitliniengerechten medikamentösen Therapie der chronischen systolischen Herzinsuffizienz bei 200 Patienten mit dilatativer Kardiomyopathie

The implementation of guidelines on medical treatment of chronic systolic heart failure in 200 patients with dilated cardiomyopathy has been investigated. Concerning the frequency of correctly prescribed drugs according to guidelines, a relatively high guideline adherence could be found in comparison to other investigations including patients with general diagnosis of heart failure. Particularly ß-RI were frequently prescribed in accordance to guidelines. Higher prescription rates and considerably increasing dosages of ACE-I, AT1-RI and ß-RI were seen at follow-up. Moreover, ß-RI prescription increased over a period of 5 years, whereas prescriptions of other drugs showed fewer differences over this period of time. This might be explained by an increase of awareness concerning the importance of ß-RI in heart failure therapy in the last years. Furthermore, there were differences in therapy between both sexes. Women had lower mean dosages of ACE-I/ AT1-RI and ß-RI than men. In addition, patients older than 60 years were less often treated according to guidelines than younger patients. Especially, this referred to lower dosages of ß-RI. Besides, treatment differed depending on physician’s speciality. Patients, who were treated inpatient or outpatient in hospital, had guideline adherent therapy more frequently than patients, who were treated by physicians in private practice. Due to partly small group sizes no other significant differences were found concerning this. In the context of multivariate statistics physician’s speciality was found to be independent predictor of global guideline adherence at baseline and accordingly patient’s age at follow-up. Additionally, female gender and older age were independently associated with lower ß-RI dosages. Possibly, this could be explained by more frequent drug intolerances. Perspectively, prescription rates of AA and dosages of ACE-I, AT1-RI resp. ß-RI should be further improved, particularly in regard to older patients and women.