Auswirkung einer leitliniengerechten Behandlung auf die Mortalität bei Linksherzinsuffizienz

verfasst von

S. Neubauer, T. Schilling, J. Zeidler, A. Lange, S. Engel, R. Linder, F. Verheyen, J. M.Graf von der Schulenburg, A. Haverich

Abstract

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.

Organisationseinheit(en)

Center for Health Economics Research Hannover (CHERH)

Externe Organisation(en)

Medizinische Hochschule Hannover (MHH)
Wissenschaftliches Institut der TK für Nutzen und Effizienz im Gesundheitswesen (WINEG)

Typ

Artikel

Journal

HERZ

Band

41

Seiten

614-624

Anzahl der Seiten

11

ISSN

0340-9937

Publikationsdatum

11.2016

Publikationsstatus

Veröffentlicht

Peer-reviewed

Ja

ASJC Scopus Sachgebiete

Kardiologie und kardiovaskuläre Medizin

Ziele für nachhaltige Entwicklung

SDG 3 – Gute Gesundheit und Wohlergehen

Elektronische Version(en)

https://doi.org/10.1007/s00059-016-4401-0 (Zugang: Geschlossen)