Table 1

Definitions of levels of guideline adherence*

Guideline levelPostreferral visit
Level 1. Drug typesTreatment with one† ACEI‡¶ or one† ARB‡, in combination with one†β-blocker and one† MRA‡ for patients with an LVEF ≤35% at baseline visit
Treatment with one† ACEI‡¶ or one† ARB‡, in combination with one† β-blocker without treatment with an MRA for patients with an LVEF >35% at baseline visit
Level 2. Drug type and doseGuideline adherent with respect to drug types and dosage of all respective guideline drugs ≥50% of the recommended target dose§
  • *As recommended by the ESC HF guidelines available at the time of patient recruitment.

  • †Exactly one.

  • ‡Only drugs with indication for treatment of HF were considered as according to guidelines. Any use of a drug from the respective class with no indication for HF led to treatment classification as non-adherent.

  • §In case a recommended target dose of an HF medication could not be defined, the criterion for guideline adherence with respect to drug dose was considered as fulfilled for this drug (independent from the actual dose).

  • ¶Alternatively: sacubitril/valsartan.

  • ACEI, ACE inhibitor; ARB, angiotensin receptor blocker; ESC, European Society of Cardiology; HF, heart failure; LVEF, left ventricular ejection fraction; MRA, mineralocorticoid receptor antagonist.