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Adherence to ACF/AHA guidelines for the management of chronic congestive heart failure in adults and its impact on patient's outcome: The Philippine Heart Center Experience.


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Publication Type
Research Project


Background. The physician's management of congestive heart failure has been known to be varied. This prospective cohort clinical study aimed to determine the adherence of physicians to the CCF/AHA practice guidelines in the management of chronic congestive heart failure (CHF) in the Philippine Heart Center (PHC) and its impact on patients' outcome.

Methods. It included 62 eligible patients diagnosed with CHF Stages C and D, admitted at PHC from June 1, 2010 to June 30, 2011. Patient who presented with acute pulmonary edema, recent myocardial infarction (1 month), cardiogenic shock, or planned surgery in the next 6 months and those who have no contact numbers were excluded. Baseline characteristics were obtained through patient interview, personal or through phone call and review of medical records. An adherence indicator was developed using two-step procedure on the basis of the five pharmacological classes pf drugs used in treatment of CHF4. The same algorithm used in the MAHLER study was used to determine whether a physician is adherent or non-adherent to the guidelines for each medication. Patients were then followed up for the occurrence of death either through phone, review medical records and through his attending physician during the index hospitalization and 6 months after discharge.

Results. The baseline characteristics did not differ significantly. Thirty five were males and 26 were females. Most of the subjects were hypertensive (n=28) and has diabetes mellitus (n=11). Almost half of the subjects (48%) had smoking history. Forty-four subjects (72%) had ejection fraction less than 40%. The medications that were often prescribed were beta-blockers (79%) diuretics (72%), cardiac glycosides (77%) and sprinolactone (79%). Most of the subjects belong to the NYHA Class II (71%) and Class III (29%). The three most common causes of the underlying causes of chronic  heart failure were rheumatic heart disease (25%), ischemic cardiomyopathy (20%) and dilated cardiomyopathy (11%). Most of the subjects were in sinus rhythm (77%). The adherence to guidelines did not differ significantly among the baseline characteristics. Out of the 61 subjects 2 (3.3%) died because of stroke and heart failure, respectively.

Conclusion. There is no significant difference between the outcome of patients with congestive heart failure who are treated according to the 2009 updated ACCF/AHA Guidelines for the diagnosis and management of heart failure and those who were treated otherwise (p-value: 1.000). However, this study is limited by an incomplete sanple size.

Keywords. Congestive Heart Failure, ACC/AHA Guidelines



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Philippine Heart Center Medical Library PHC.R.051.09 Fulltext Print Format

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