• Michel Komajda, Stefan D Anker, Martin R Cowie, Gerasimos S Filippatos, Bastian Mengelle, Piotr Ponikowski, Luigi Tavazzi, and QUALIFY Investigators.
• Institute of Cardiometabolism and Nutrition (ICAN), Pierre & Marie Curie Paris VI University, La Pitié-Salpétrière Hospital, AP-HP, 47-83 Boulevard de l'Hôpital, 75013, Paris, France.
• Eur. J. Heart Fail. 2016 May 1; 18 (5): 514-22.

AimsTo assess physicians' adherence to guideline-recommended medications for the treatment of chronic heart failure (CHF) with reduced ejection fraction.Methods And ResultsQUALIFY is an international prospective observational longitudinal survey of 7092 CHF outpatients recruited 1-15 months after hospitalization for heart failure from September 2013 to December 2014 in 547 centres in 36 countries. We constructed a five-class guideline adherence score for angiotensin converting enzyme inhibitors (ACEIs), beta-blockers, angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists, and ivabradine. The adherence score was good in 67%, moderate in 25%, and poor in 8% of patients. Adherence was lower in women than men but there were differences in age (65.7 ± 12.5 years women vs. 62.2 ± 12.4 years men, P < 0.001) and the proportion of women at ≥50% target dose of beta-blockers was lower in those >67 years (median) (11% vs. 16.2%, P = 0.005). Geographic variations were observed with lower adherence scores in Central/Eastern European countries. The proportion of patients at target dose and ≥50% of target dose was low (27.9% and 63.3% for ACEIs, 14.8% and 51.8% for beta-blockers, 6.9% and 39.5% for ARBs, and 6.9% and 39.5% for ivabradine, respectively). It was also lower in patients most recently hospitalized (<6  vs. ≥6 months) except for beta-blockers.ConclusionThis international survey shows that adherence to guideline-recommended medications is relatively satisfactory but the dosage of recommended CHF medications is usually suboptimal. Action plans aimed at improving adherence to guidelines are required.© 2016 The Authors. European Journal of Heart Failure © 2016 European Society of Cardiology.

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