{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T17:56:13Z","timestamp":1793382973904,"version":"4.5.0"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2017,4,30]],"date-time":"2017-04-30T00:00:00Z","timestamp":1493510400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Servier, France"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>To evaluate the impact of physicians' adherence to guideline-recommended medications for heart failure with reduced ejection fraction (HFrEF), including \u226550% prescription of recommended doses, on clinical outcomes at 6-month follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>In QUALIFY, an international, prospective, observational, longitudinal survey, 6669 outpatients with HFrEF were recruited 1\u201315 months after heart failure (HF) hospitalization from September 2013 to December 2014 in 36 countries and followed up at 6 months. A global adherence to guidelines score was developed for prescription of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), beta-blockers (BBs), mineralocorticoid receptor antagonists (MRAs) and ivabradine and their dosages. Baseline global adherence score was good in 23% of patients, moderate in 55%, and poor in 22%. At 6-month follow-up, poor adherence was associated with significantly higher overall mortality [hazard ratio (HR) 2.21, 95% confidence interval (CI) 1.42\u20133.44, P=0.001], cardiovascular mortality (HR 2.27, 95% CI 1.36\u20133.77, P=0.003), HF mortality (HR 2.26, 95% CI 1.21\u20134.2, P=0.032), combined HF hospitalization or HF death (HR 1.26, 95% CI 1.08\u20131.71, P=0.024) and cardiovascular hospitalization or cardiovascular death (HR 1.35, 95% CI 1.08\u20131.69, P=0.013). There was a strong trend between poor adherence and HF hospitalization (HR 1.32, 95% CI 1.04\u20131.68, P=0.069).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Good adherence to pharmacologic treatment guidelines for ACEIs, ARBs, BBs, MRAs and ivabradine, with prescription of at least 50% of recommended dosages, was associated with better clinical outcomes during 6-month follow-up. Continuing global educational initiatives are needed to emphasise the importance of guideline recommendations for optimising drug therapy and prescribing evidence-based doses in clinical practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.887","type":"journal-article","created":{"date-parts":[[2017,5,2]],"date-time":"2017-05-02T10:00:42Z","timestamp":1493719242000},"page":"1414-1423","source":"Crossref","is-referenced-by-count":225,"title":["PHysicians' Guideline Adherence is Associated with Better Prognosis in Outpatients with Heart Failure with Reduced Ejection Fraction: The QUALIFY International Registry"],"prefix":"10.1093","volume":"19","author":[{"given":"Michel","family":"Komajda","sequence":"first","affiliation":[{"name":"Institute of Cardiometabolism and Nutrition (ICAN), Pierre et Marie Curie University, Paris VI, La Piti\u00e9-Salp\u00e9tri\u00e8re Hospital , Paris ,","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin R.","family":"Cowie","sequence":"additional","affiliation":[{"name":"Imperial College London, Royal Brompton Hospital , London ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luigi","family":"Tavazzi","sequence":"additional","affiliation":[{"name":"Maria Cecilia Hospital, GVM Care & Research, Ettore Sansavini Health Science Foundation , Cotignola ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Ponikowski","sequence":"additional","affiliation":[{"name":"Medical University, Faculty of Public Health , Wroclaw ,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan D.","family":"Anker","sequence":"additional","affiliation":[{"name":"Innovative Clinical Trials, Department of Cardiology and Pneumology, University Medical Center G\u00f6ttingen (UMG) , G\u00f6ttingen ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerasimos S.","family":"Filippatos","sequence":"additional","affiliation":[{"name":"National and Kapodistrian University of Athens, School of Medicine, Athens University Hospital Attikon , Athens ,","place":["Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2017,4,30]]},"reference":[{"key":"2026011721201015700_ejhf887-bib-0001","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1161\/CIRCHEARTFAILURE.112.000161","article-title":"Multicenter prospective observational study on acute and chronic heart failure: the one-year follow-up results of IN-HF outcome registry","volume":"6","author":"Tavazzi","year":"2013","journal-title":"Circ Heart Fail"},{"key":"2026011721201015700_ejhf887-bib-0002","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1093\/eurjhf\/hft050","article-title":"EURObservational Research Programme: regional differences and 1-year follow-up results of the Heart Failure Pilot Survey (ESC-HF Pilot)","volume":"15","author":"Maggioni","year":"2013","journal-title":"Eur J Heart Fail"},{"key":"2026011721201015700_ejhf887-bib-0003","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1016\/j.jacc.2013.11.053","article-title":"The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries","volume":"63","author":"Ambrosy","year":"2014","journal-title":"J Am Coll Cardiol"},{"key":"2026011721201015700_ejhf887-bib-0004","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1002\/ejhf.262","article-title":"International REgistry to assess medical Practice with lOngitudinal obseRvation for Treatment of Heart Failure (REPORT-HF): rationale for and design of a global registry","volume":"17","author":"Filippatos","year":"2015","journal-title":"Eur J Heart Fail"},{"key":"2026011721201015700_ejhf887-bib-0005","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1002\/ejhf.592","article-title":"2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)","volume":"18","author":"Ponikowski","year":"2016","journal-title":"Eur J Heart Fail"},{"key":"2026011721201015700_ejhf887-bib-0006","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1161\/CIRCHEARTFAILURE.108.772228","article-title":"Heart failure care in the outpatient cardiology practice setting: findings from IMPROVE HF","volume":"1","author":"Fonarow","year":"2008","journal-title":"Circ Heart Fail"},{"key":"2026011721201015700_ejhf887-bib-0007","author":"British Society for Heart Failure","year":"2017"},{"key":"2026011721201015700_ejhf887-bib-0008","doi-asserted-by":"crossref","first-page":"1653","DOI":"10.1093\/eurheartj\/ehi251","article-title":"Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey","volume":"26","author":"Komajda","year":"2005","journal-title":"Eur Heart J"},{"key":"2026011721201015700_ejhf887-bib-0009","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1093\/eurjhf\/hft134","article-title":"Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12,440 patients of the ESC Heart Failure Long-Term Registry","volume":"15","author":"Maggioni","year":"2013","journal-title":"Eur J Heart Fail"},{"key":"2026011721201015700_ejhf887-bib-0010","doi-asserted-by":"crossref","first-page":"2312","DOI":"10.1161\/01.CIR.100.23.2312","article-title":"Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure","volume":"100","author":"Packer","year":"1999","journal-title":"Circulation"},{"key":"2026011721201015700_ejhf887-bib-0011","doi-asserted-by":"crossref","first-page":"1840","DOI":"10.1016\/S0140-6736(09)61913-9","article-title":"Effects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure (HEAAL study): a randomised, double-blind trial","volume":"374","author":"Konstam","year":"2009","journal-title":"Lancet"},{"key":"2026011721201015700_ejhf887-bib-0012","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1093\/eurjhf\/hfs105","article-title":"ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC","volume":"14","author":"McMurray","year":"2012","journal-title":"Eur J Heart Fail"},{"key":"2026011721201015700_ejhf887-bib-0013","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1002\/ejhf.510","article-title":"Physicians' adherence to guideline-recommended medications in heart failure with reduced ejection fraction: data from the QUALIFY global survey","volume":"18","author":"Komajda","year":"2016","journal-title":"Eur J Heart Fail"},{"key":"2026011721201015700_ejhf887-bib-0014","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1016\/S0140-6736(10)61198-1","article-title":"Ivabradine and outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study","volume":"376","author":"Swedberg","year":"2010","journal-title":"Lancet"},{"key":"2026011721201015700_ejhf887-bib-0015","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1093\/eurheartj\/ehx026","article-title":"Determinants and clinical outcome of uptitration of ACE-inhibitors and beta-blockers in patients with heart failure: a prospective European study","volume":"38","author":"Ouwerkerk","year":"2017","journal-title":"Eur Heart J"},{"key":"2026011721201015700_ejhf887-bib-0016","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0086596","article-title":"SUrvey of Guideline Adherence for Treatment of Systolic Heart Failure in Real World (SUGAR): a multi-center, retrospective, observational study","volume":"9","author":"Yoo","year":"2014","journal-title":"PLoS One"},{"key":"2026011721201015700_ejhf887-bib-0017","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.ijcard.2014.04.255","article-title":"Dose matters! Optimisation of guideline adherence is associated with lower mortality in stable patients with chronic heart failure","volume":"175","author":"Poelzl","year":"2014","journal-title":"Int J Cardiol"},{"key":"2026011721201015700_ejhf887-bib-0018","doi-asserted-by":"crossref","first-page":"2807","DOI":"10.1161\/01.CIR.94.11.2807","article-title":"Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure","volume":"94","author":"Bristow","year":"1996","journal-title":"Circulation"},{"key":"2026011721201015700_ejhf887-bib-0019","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1016\/S0735-1097(02)01970-8","article-title":"Dose of metoprolol CR\/XL and clinical outcomes in patients with heart failure: analysis of the experience in metoprolol CR\/XL randomized intervention trial in chronic heart failure (MERIT-HF)","volume":"40","author":"Wikstrand","year":"2002","journal-title":"J Am Coll Cardiol"},{"key":"2026011721201015700_ejhf887-bib-0020","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1016\/S0195-668X(02)00743-1","article-title":"Bisoprolol dose\u2013response relationship in patients with congestive heart failure: a subgroup analysis in the cardiac insufficiency bisoprolol study (CIBIS II)","volume":"24","author":"Simon","year":"2003","journal-title":"Eur Heart J"},{"key":"2026011721201015700_ejhf887-bib-0021","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1093\/eurjhf\/hfp142","article-title":"Adherence to medication according to sex and age in the CHARM programme","volume":"11","author":"Granger","year":"2009","journal-title":"Eur J Heart Fail"},{"issue":"11 Suppl","key":"2026011721201015700_ejhf887-bib-0022","first-page":"S212","article-title":"Evaluation of the treatment gap between clinical guidelines and the utilization of renin-angiotensin-aldosterone system inhibitors","volume":"21","author":"Epstein","year":"2015","journal-title":"Am J Manag Care"},{"key":"2026011721201015700_ejhf887-bib-0023","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1186\/2049-3258-72-37","article-title":"Adherence influencing factors\u2014a systematic review of systematic reviews","volume":"72","author":"Mathes","year":"2014","journal-title":"Arch Public Health"},{"key":"2026011721201015700_ejhf887-bib-0024","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1007\/s00392-013-0642-6","article-title":"The effect of placebo adherence on reducing cardiovascular mortality: a meta-analysis","volume":"103","author":"Yue","year":"2014","journal-title":"Clin Res Cardiol"},{"key":"2026011721201015700_ejhf887-bib-0025","doi-asserted-by":"crossref","first-page":"2005","DOI":"10.1016\/S0140-6736(05)67760-4","article-title":"Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: double-blind, randomised, controlled clinical trial","volume":"366","author":"Granger","year":"2005","journal-title":"Lancet"},{"key":"2026011721201015700_ejhf887-bib-0026","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1093\/eurjhf\/hfn005","article-title":"Improvement in the management of chronic heart failure since the publication of the updated guidelines of the European Society of Cardiology. The Impact-Reco-Programme","volume":"11","author":"De Groote","year":"2009","journal-title":"Eur J Heart Fail"},{"key":"2026011721201015700_ejhf887-bib-0027","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1093\/eurheartj\/ehn539","article-title":"Contemporary management of octogenarians hospitalized for heart failure in Europe: Euro Heart Failure Survey II","volume":"30","author":"Komajda","year":"2009","journal-title":"Eur Heart J"},{"key":"2026011721201015700_ejhf887-bib-0028","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1161\/CIRCHEARTFAILURE.113.000163","article-title":"Practice-level variation in use of recommended medications among outpatients with heart failure: insights from the NCDR PINNACLE program","volume":"6","author":"Peterson","year":"2013","journal-title":"Circ Heart Fail"},{"key":"2026011721201015700_ejhf887-bib-0029","doi-asserted-by":"crossref","first-page":"1098","DOI":"10.1016\/j.jval.2015.08.005","article-title":"Appropriateness of prescriptions of recommended treatments in Organisation for Economic Co-operation and Development Health Systems: findings based on the Long-Term Registry of the European Society of Cardiology on Heart Failure","volume":"18","author":"Maggioni","year":"2015","journal-title":"Value Health"},{"key":"2026011721201015700_ejhf887-bib-0030","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1159\/000453655","article-title":"Use and disuse of observational research: the case of remote monitoring in heart failure","volume":"137","author":"Tavazzi","year":"2016","journal-title":"Cardiology"}],"container-title":["European Journal of Heart Failure"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fejhf.887","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/eurjhf\/article-pdf\/19\/11\/1414\/66327435\/eurjhf_19_11_1414.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/eurjhf\/article-pdf\/19\/11\/1414\/66327435\/eurjhf_19_11_1414.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T02:22:26Z","timestamp":1768702946000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/eurjhf\/article\/19\/11\/1414\/8418448"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,4,30]]},"references-count":30,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2017,4,30]]},"published-print":{"date-parts":[[2017,11,1]]}},"URL":"https:\/\/doi.org\/10.1002\/ejhf.887","relation":{},"ISSN":["1388-9842","1879-0844"],"issn-type":[{"value":"1388-9842","type":"print"},{"value":"1879-0844","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2017,11]]},"published":{"date-parts":[[2017,4,30]]}}}