University of Groningen Heart failure guidelines and prescribing in primary care across Europe

Background: Major international differences in heart failure treatment have been repeatedly described, but the reasons for these differences remain unclear. National guideline recommendations might be a relevant factor. This study, therefore, explored variation of heart failure guideline recommendations in Europe. Methods: Treatment recommendations of 14 national guidelines published after 1994 were analyzed in relation to the heart failure treatment guideline of the European Society of Cardiology. To test potential relations between recommendations and prescribing, national prescribing patterns as obtained by a European study in primary care (IMPROVEMENT-HF) were related to selected recommendations in those countries. Results: Besides the 14 national guidelines used by primary care physicians in the countries contacted, the European guideline was used in four countries, and separate guidelines for specialists and primary care were available in another four countries. Two countries indicated that no guideline was used up to 2000. Comprehensiveness of the guidelines varied with respect to length, literature included and evidence ratings. Relevant differences in treatment recommendations were seen only in drug classes where evidence had changed recently (β-blockers and spironolactone). The relation between recommendation and prescribing for selected recommendations was inconsistent among countries. Conclusion: Differences in guideline recommendations are not sufficient to explain variation of prescribing among countries, thus other factors must be considered. Background Chronic heart failure is a common disease in all developed countries, and its prevalence is likely to increase further due to aging societies and improvement in therapies [1]. Therefore, the interest in good quality of heart failure management is twofold: optimal medical outcomes as well as the efficient use of resources. Published: 30 August 2005 BMC Health Services Research 2005, 5:57 doi:10.1186/1472-6963-5-57 Received: 29 November 2004 Accepted: 30 August 2005 This article is available from: http://www.biomedcentral.com/1472-6963/5/57 © 2005 Sturm et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. BMC Health Services Research 2005, 5:57 http://www.biomedcentral.com/1472-6963/5/57