A tool for assessment of heart failure prescribing quality: A systematic review and meta‐analysis

Introduction: Heart failure (HF) guidelines aim to standardise patient care. Internationally, prescribing practice in HF may deviate from guidelines and so a standardised tool is required to assess prescribing quality. A systematic review and meta‐analysis were performed to identify a quantitative tool for measuring adherence to HF guidelines and its clinical implications. Methods: Eleven electronic databases were searched to include studies reporting a comprehensive tool for measuring adherence to prescribing guidelines in HF patients aged ≥18 years. Qualitative studies or studies measuring prescription rates alone were excluded. Study quality was assessed using the Good ReseArch for Comparative Effectiveness Checklist. Results: In total, 2455 studies were identified. Sixteen eligible full‐text articles were included (n = 14 354 patients, mean age 69 ± 8 y). The Guideline Adherence Index (GAI), and its modified versions, was the most frequently cited tool (n = 13). Other tools identified were the Individualised Reconciled Evidence Recommendations, the Composite Heart Failure Performance, and the Heart Failure Scale. The meta‐analysis included the GAI studies of good to high quality. The average GAI‐3 was 62%. Compared to low GAI, high GAI patients had lower mortality rate (7.6% vs 33.9%) and lower rehospitalisation rates (23.5% vs 24.5%); both P ≤ .05. High GAI was associated with reduced risk of mortality (hazard ratio = 0.29, 95% confidence interval, 0.06‐0.51) and rehospitalisation (hazard ratio = 0.64, 95% confidence interval, 0.41‐1.00). No tool was used to improve prescribing quality. Conclusion: The GAI is the most frequently used tool to assess guideline adherence in HF. High GAI is associated with improved HF outcomes.