Arehospitalizedor ambulatorypatientswithheart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12 440 patients of the ESC Heart Failure Long-Term Registry

Aims To evaluate how recommendations of European guidelines regarding pharmacological and non-pharmacological treatments for heart failure (HF) are adopted in clinical practice. Methods and results The ESC-HF Long-Term Registry is a prospective, observational study conducted in 211 Cardiology Centres of 21 European and Mediterranean countries, members of the European Society of Cardiology (ESC). FromMay2011 to April 2013, a total of 12 440 patients were enrolled, 40.5% with acuteHFand 59.5% with chronicHF. Intravenoustreatments for acute HF were heterogeneously administered, irrespective of guideline recommendations. In chronic HF, with reduced EF, renin–angiotensin system (RAS) blockers, beta-blockers, and mineralocorticoid antagonists (MRAs) were used in 92.2, 92.7, and 67.0% of patients, respectively.Whenreasons for non-adherencewere considered, the real rate of undertreatment accounted for 3.2, 2.3, and 5.4% of the cases, respectively. About 30% of patients received the target dosage of these drugs, but a documented reason for not achieving the target dosagewas reported in almost two-thirds of them. The morerelevant reasons for non-implantation of a device, when clinically indicated,were related to doctor uncertainties on the indication, patient refusal, or logistical/cost issues. Conclusion This pan-European registry shows that, while in patients with acute HF, a large heterogeneity of treatments exists, drug treatment of chronicHFcan be considered largely adherent to recommendations of current guidelines, whenthe reasons for non-adherence are taken into account. Observations regarding the real possibility to adhere fully to current guidelines in daily clinical practice should be seriously considered when clinical practice guidelines have to be written.