Other Publication Details
Mandatory Fields
Reviews
El Hadidi, S;Darweesh, E;Byrne, S;Bermingham, M
2018
July
A tool for assessment of heart failure prescribing quality: A systematic review and meta-analysis
Validated
1
Optional Fields
PRIMARY-CARE GUIDELINE ADHERENCE OF-CARE MORTALITY ASSOCIATION MEDICATION MORBIDITY HOSPITALS REGISTRY THERAPY
Introduction: Heart failure (HF) guidelines aim to standardise patient care. Internationally, prescribing practice in HF may deviate from guidelines and so a standardised tool is required to assess prescribing quality. A systematic review and meta-analysis were performed to identify a quantitative tool for measuring adherence to HF guidelines and its clinical implications. Methods: Eleven electronic databases were searched to include studies reporting a comprehensive tool for measuring adherence to prescribing guidelines in HF patients aged >= 18 years. Qualitative studies or studies measuring prescription rates alone were excluded. Study quality was assessed using the Good ReseArch for Comparative Effectiveness Checklist. Results: In total, 2455 studies were identified. Sixteen eligible full-text articles were included (n = 14 354 patients, mean age 69 +/- 8 y). The Guideline Adherence Index (GAI), and its modified versions, was the most frequently cited tool (n = 13). Other tools identified were the Individualised Reconciled Evidence Recommendations, the Composite Heart Failure Performance, and the Heart Failure Scale. The meta-analysis included the GAI studies of good to high quality. The average GAI-3 was 62%. Compared to low GAI, high GAI patients had lower mortality rate (7.6% vs 33.9%) and lower rehospitalisation rates (23.5% vs 24.5%); both P=.05. High GAI was associated with reduced risk of mortality (hazard ratio = 0.29, 95% confidence interval, 0.06-0.51) and rehospitalisation (hazard ratio = 0.64, 95% confidence interval, 0.41-1.00). No tool was used to improve prescribing quality. Conclusion: The GAI is the most frequently used tool to assess guideline adherence in HF. High GAI is associated with improved HF outcomes.
HOBOKEN
WILEY
1053-8569
685
694
10.1002/pds.4430
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