Prevention of stroke in atrial fibrillation: desired and real

The analysis of the data ot the register of patients with atrial fibrillation (retrospective part -1860 patients, prospective observation - 498 patients), which were observed in the period 2009-2017 in outpatient facilities and hospitals in Moscow, is presented. The dynamics of the appointment of antithrombotic drugs of various groups in routine clinical practice and in conditions of observation in an anticoagulant room on the basis of a day hospital were studied. The results are compared with data from other domestic observational studies of patients with atrial fibrillation. Other ways to improve the quality of antithrombotic prophylaxis are discussed.Представлен анализ данных регистра пациентов с фибрилляцией предсердий (ретроспективная часть -1860 пациентов, проспективное наблюдение - 498 пациентов), наблюдавшихся в период 2009-2017годы в амбулаторных учреждениях и стационарах г. Москвы. Исследована динамика назначения антитромботических препаратов различных групп в рутинной клинической практике и в условиях наблюдения в антикоагулянтном кабинете на базе дневного стационара. Результаты сопоставлены с данными других отечественных наблюдательных исследований пациентов с фибрилляцией предсердий. Обсуждаются другие способы повышения качества антитромботической профилактики

Physicians' guideline adherence is associated with long-term heart failure mortality in outpatients with heart failure with reduced ejection fraction: the QUALIFY international registry

Background: Physicians' adherence to guideline-recommended therapy is associated with short-term clinical outcomes in heart failure (HF) with reduced ejection fraction (HFrEF). However, its impact on longer-term outcomes is poorly documented. Here, we present results from the 18-month follow-up of the QUALIFY registry. Methods and results: Data at 18 months were available for 6118 ambulatory HFrEF patients from this international prospective observational survey. Adherence was measured as a continuous variable, ranging from 0 to 1, and was assessed for five classes of recommended HF medications and dosages. Most deaths were cardiovascular (CV) (228/394) and HF-related (191/394) and the same was true for unplanned hospitalizations (1175 CV and 861 HF-related hospitalizations, out of a total of 1541). According to univariable analysis, CV and HF deaths were significantly associated with physician adherence to guidelines. In multivariable analysis, HF death was associated with adherence level [subdistribution hazard ratio (SHR) 0.93, 95% confidence interval (CI) 0.87–0.99 per 0.1 unit adherence level increase; P = 0.034] as was composite of HF hospitalization or CV death (SHR 0.97, 95% CI 0.94–0.99 per 0.1 unit adherence level increase; P = 0.043), whereas unplanned all-cause, CV or HF hospitalizations were not (all-cause: SHR 0.99, 95% CI 0.9–1.02; CV: SHR 0.98, 95% CI 0.96–1.01; and HF: SHR 0.99, 95% CI 0.96–1.02 per 0.1 unit change in adherence score; P = 0.52, P = 0.2, and P = 0.4, respectively). Conclusion: These results suggest that physicians' adherence to guideline-recommended HF therapies is associated with improved outcomes in HFrEF. Practical strategies should be established to improve physicians' adherence to guidelines. © 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiolog