Adherence to treatment guidelines and its association with length of hospital stay for patients with decompensated heart failure and reduced ejection fraction

Funding Acknowledgements: The work was supported by the Research Council of Lithuania, grant Nr. MIP-049/2015 and approved by Lithuanian Bioethics Com- mittee, Nr. L-15-01. Introduction: Heart failure (HF) is a major and growing public health problem. Currently, HF is the main reason of hospitalisation for patients aged over 65 and it imposes a significant economic burden on health care systems. Medication onadherence is associated with an increased risk of all-cause mortality and car- diovascular hospitalisations in patients with HF. Purpose: We aimed to investigate adherence to HF guidelines for drug therapy and the association between adherence and length of hospital stay for HF patients hos- pitalised due to acute dyspnea. Methods: Prospective observational cohort study enrolled 837 consecutive patients admitted to the emergency department with acute dyspnea between March 2015 and December 2016. Out of 837 examined patients, 187 patients (22.3%) were included in the analysis after being hospitalised and discharged with final diag- nosis of acute HF with reduced left ventricular ejection fraction (LVEF 40% (9.2%), cardiac arrhyth- mia (8.8%), pulmonary embolism (6.9%), pulmonary infection (6.8%), acute coronary syndrome (4.5%), chronic obstructive pulmonary disease (4.3%), cancer (3.0%), hypertension (1.8%), anxiety (1.6%) were excluded. Adherence was evaluated using guideline adherence indicator (GAI3), which is defined as the proportion of care across main three therapeutic classes (angiotensin-converting-enzyme inhibitors (ACEIs), beta-blockers (BBs) and mineralocorticoid receptor antagonists (MRAs) ) according to current European Society of Cardiology (ESC) HF treatment guidelines. Patients were categorised into 3 groups based on the GAI3 values (good, 100% intermediate, 50–67% poor, 0-33%). A general linear model was used to assess the effect of pre-hospital GAI3 [...]