SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real World (SUGAR): A multi-center, retrospective, observational study

Byung Su Yoo; Jaewon Oh; Bum Kee Hong; Dae Hee Shin; Jang Ho Bae; Dong Heon Yang; Wan Joo Shim; Hyung Seop Kim; Su Hong Kim; Jin Oh Choi; Woo Jung Chun; Choong Won Go; Hyun Jae Kang; Sang Hong Baek; Jang Hyun Cho; Suk Keun Hong; Joon Han Shin; Seok Kyu Oh; Wook Bum Pyun; Jun Kwan; Young Joon Hong; Jin Ok Jeong; Seok Min Kang; Dong Ju Choi

doi:10.1371/journal.pone.0086596

SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real World (SUGAR): A multi-center, retrospective, observational study

Byung Su Yoo, Jaewon Oh, Bum Kee Hong, Dae Hee Shin, Jang Ho Bae, Dong Heon Yang, Wan Joo Shim, Hyung Seop Kim, Su Hong Kim, Jin Oh Choi, Woo Jung Chun, Choong Won Go, Hyun Jae Kang, Sang Hong Baek, Jang Hyun Cho, Suk Keun Hong, Joon Han Shin, Seok Kyu Oh, Wook Bum Pyun, Jun KwanYoung Joon Hong, Jin Ok Jeong, Seok Min Kang, Dong Ju Choi

Department of Internal Medicine

Research output: Contribution to journal › Article › peer-review

33 Scopus citations

Abstract

Background: Clinical practice guidelines have been slowly and inconsistently applied in clinical practice, and certain evidence-based, guideline-driven therapies for heart failure (HF) have been significantly underused. The purpose of this study was to survey guideline compliance and its effect on clinical outcomes in the treatment of systolic HF in Korea. Method and Results: The SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real World (SUGAR) trial was a multi-center, retrospective, observational study on subjects with systolic HF (ejection fraction <45%) admitted to 23 university hospitals. The guideline adherence indicator (GAI) was defined as a performance measure on the basis of 3 pharmacological classes: angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), beta-blocker (BB), and aldosterone antagonist (AA). Based on the overall adherence percentage, subjects were divided into 2 groups: those with good guideline adherence (GAI ≥50%) and poor guideline adherence (GAI <50%). We included 1319 regional participants as representatives of the standard population from the Korean national census in 2008. Adherence to drugs at discharge was as follows: ACEI or ARB, 89.7%; BB, 69.2%; and AA, 65.9%. Overall, 82.7% of the patients had good guideline adherence. Overall mortality and re-hospitalization rates at 1 year were 6.2% and 37.4%, respectively. Survival analysis by log-rank test showed a significant difference in event-free survival rate of mortality (94.7% vs. 89.8%, p = 0.003) and re-hospitalization (62.3% vs. 56.4%, p = 0.041) between the good and poor guideline-adherence groups. Conclusions: Among patients with systolic HF in Korea, adherence to pharmacologic treatment guidelines as determined by performance measures, including prescription of ACEI/ARB and BB at discharge, was associated with improved clinical outcomes.

Original language	English
Article number	e86596
Journal	PLoS ONE
Volume	9
Issue number	1
DOIs	https://doi.org/10.1371/journal.pone.0086596
State	Published - 27 Jan 2014

Bibliographical note

Funding Information:
This study was supported by a grant of GlaxoSmithKline Korea. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. This funding does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials. Every author declared their commercial declaration using ICMJE form for disclosure of potential conflicts of interest. The authors attached two ICMJE forms (pdf file) of first and corresponding author as representative.

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Yoo, B. S., Oh, J., Hong, B. K., Shin, D. H., Bae, J. H., Yang, D. H., Shim, W. J., Kim, H. S., Kim, S. H., Choi, J. O., Chun, W. J., Go, C. W., Kang, H. J., Baek, S. H., Cho, J. H., Hong, S. K., Shin, J. H., Oh, S. K., Pyun, W. B., ... Choi, D. J. (2014). SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real World (SUGAR): A multi-center, retrospective, observational study. PLoS ONE, 9(1), Article e86596. https://doi.org/10.1371/journal.pone.0086596

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title = "SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real World (SUGAR): A multi-center, retrospective, observational study",

abstract = "Background: Clinical practice guidelines have been slowly and inconsistently applied in clinical practice, and certain evidence-based, guideline-driven therapies for heart failure (HF) have been significantly underused. The purpose of this study was to survey guideline compliance and its effect on clinical outcomes in the treatment of systolic HF in Korea. Method and Results: The SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real World (SUGAR) trial was a multi-center, retrospective, observational study on subjects with systolic HF (ejection fraction <45%) admitted to 23 university hospitals. The guideline adherence indicator (GAI) was defined as a performance measure on the basis of 3 pharmacological classes: angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), beta-blocker (BB), and aldosterone antagonist (AA). Based on the overall adherence percentage, subjects were divided into 2 groups: those with good guideline adherence (GAI ≥50%) and poor guideline adherence (GAI <50%). We included 1319 regional participants as representatives of the standard population from the Korean national census in 2008. Adherence to drugs at discharge was as follows: ACEI or ARB, 89.7%; BB, 69.2%; and AA, 65.9%. Overall, 82.7% of the patients had good guideline adherence. Overall mortality and re-hospitalization rates at 1 year were 6.2% and 37.4%, respectively. Survival analysis by log-rank test showed a significant difference in event-free survival rate of mortality (94.7% vs. 89.8%, p = 0.003) and re-hospitalization (62.3% vs. 56.4%, p = 0.041) between the good and poor guideline-adherence groups. Conclusions: Among patients with systolic HF in Korea, adherence to pharmacologic treatment guidelines as determined by performance measures, including prescription of ACEI/ARB and BB at discharge, was associated with improved clinical outcomes.",

author = "Yoo, {Byung Su} and Jaewon Oh and Hong, {Bum Kee} and Shin, {Dae Hee} and Bae, {Jang Ho} and Yang, {Dong Heon} and Shim, {Wan Joo} and Kim, {Hyung Seop} and Kim, {Su Hong} and Choi, {Jin Oh} and Chun, {Woo Jung} and Go, {Choong Won} and Kang, {Hyun Jae} and Baek, {Sang Hong} and Cho, {Jang Hyun} and Hong, {Suk Keun} and Shin, {Joon Han} and Oh, {Seok Kyu} and Pyun, {Wook Bum} and Jun Kwan and Hong, {Young Joon} and Jeong, {Jin Ok} and Kang, {Seok Min} and Choi, {Dong Ju}",

note = "Funding Information: This study was supported by a grant of GlaxoSmithKline Korea. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. This funding does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials. Every author declared their commercial declaration using ICMJE form for disclosure of potential conflicts of interest. The authors attached two ICMJE forms (pdf file) of first and corresponding author as representative. ",

year = "2014",

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Yoo, BS, Oh, J, Hong, BK, Shin, DH, Bae, JH, Yang, DH, Shim, WJ, Kim, HS, Kim, SH, Choi, JO, Chun, WJ, Go, CW, Kang, HJ, Baek, SH, Cho, JH, Hong, SK, Shin, JH, Oh, SK, Pyun, WB, Kwan, J, Hong, YJ, Jeong, JO, Kang, SM & Choi, DJ 2014, 'SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real World (SUGAR): A multi-center, retrospective, observational study', PLoS ONE, vol. 9, no. 1, e86596. https://doi.org/10.1371/journal.pone.0086596

TY - JOUR

T1 - SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real World (SUGAR)

T2 - A multi-center, retrospective, observational study

AU - Yoo, Byung Su

AU - Oh, Jaewon

AU - Hong, Bum Kee

AU - Shin, Dae Hee

AU - Bae, Jang Ho

AU - Yang, Dong Heon

AU - Shim, Wan Joo

AU - Kim, Hyung Seop

AU - Kim, Su Hong

AU - Choi, Jin Oh

AU - Chun, Woo Jung

AU - Go, Choong Won

AU - Kang, Hyun Jae

AU - Baek, Sang Hong

AU - Cho, Jang Hyun

AU - Hong, Suk Keun

AU - Shin, Joon Han

AU - Oh, Seok Kyu

AU - Pyun, Wook Bum

AU - Kwan, Jun

AU - Hong, Young Joon

AU - Jeong, Jin Ok

AU - Kang, Seok Min

AU - Choi, Dong Ju

N1 - Funding Information: This study was supported by a grant of GlaxoSmithKline Korea. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. This funding does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials. Every author declared their commercial declaration using ICMJE form for disclosure of potential conflicts of interest. The authors attached two ICMJE forms (pdf file) of first and corresponding author as representative.

PY - 2014/1/27

Y1 - 2014/1/27

N2 - Background: Clinical practice guidelines have been slowly and inconsistently applied in clinical practice, and certain evidence-based, guideline-driven therapies for heart failure (HF) have been significantly underused. The purpose of this study was to survey guideline compliance and its effect on clinical outcomes in the treatment of systolic HF in Korea. Method and Results: The SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real World (SUGAR) trial was a multi-center, retrospective, observational study on subjects with systolic HF (ejection fraction <45%) admitted to 23 university hospitals. The guideline adherence indicator (GAI) was defined as a performance measure on the basis of 3 pharmacological classes: angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), beta-blocker (BB), and aldosterone antagonist (AA). Based on the overall adherence percentage, subjects were divided into 2 groups: those with good guideline adherence (GAI ≥50%) and poor guideline adherence (GAI <50%). We included 1319 regional participants as representatives of the standard population from the Korean national census in 2008. Adherence to drugs at discharge was as follows: ACEI or ARB, 89.7%; BB, 69.2%; and AA, 65.9%. Overall, 82.7% of the patients had good guideline adherence. Overall mortality and re-hospitalization rates at 1 year were 6.2% and 37.4%, respectively. Survival analysis by log-rank test showed a significant difference in event-free survival rate of mortality (94.7% vs. 89.8%, p = 0.003) and re-hospitalization (62.3% vs. 56.4%, p = 0.041) between the good and poor guideline-adherence groups. Conclusions: Among patients with systolic HF in Korea, adherence to pharmacologic treatment guidelines as determined by performance measures, including prescription of ACEI/ARB and BB at discharge, was associated with improved clinical outcomes.

AB - Background: Clinical practice guidelines have been slowly and inconsistently applied in clinical practice, and certain evidence-based, guideline-driven therapies for heart failure (HF) have been significantly underused. The purpose of this study was to survey guideline compliance and its effect on clinical outcomes in the treatment of systolic HF in Korea. Method and Results: The SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real World (SUGAR) trial was a multi-center, retrospective, observational study on subjects with systolic HF (ejection fraction <45%) admitted to 23 university hospitals. The guideline adherence indicator (GAI) was defined as a performance measure on the basis of 3 pharmacological classes: angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor II blocker (ARB), beta-blocker (BB), and aldosterone antagonist (AA). Based on the overall adherence percentage, subjects were divided into 2 groups: those with good guideline adherence (GAI ≥50%) and poor guideline adherence (GAI <50%). We included 1319 regional participants as representatives of the standard population from the Korean national census in 2008. Adherence to drugs at discharge was as follows: ACEI or ARB, 89.7%; BB, 69.2%; and AA, 65.9%. Overall, 82.7% of the patients had good guideline adherence. Overall mortality and re-hospitalization rates at 1 year were 6.2% and 37.4%, respectively. Survival analysis by log-rank test showed a significant difference in event-free survival rate of mortality (94.7% vs. 89.8%, p = 0.003) and re-hospitalization (62.3% vs. 56.4%, p = 0.041) between the good and poor guideline-adherence groups. Conclusions: Among patients with systolic HF in Korea, adherence to pharmacologic treatment guidelines as determined by performance measures, including prescription of ACEI/ARB and BB at discharge, was associated with improved clinical outcomes.

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DO - 10.1371/journal.pone.0086596

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ER -

SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real World (SUGAR): A multi-center, retrospective, observational study

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