Observational studyBMJ open2025
Heart failure in Southern Sweden (HISS): a cross-sectional analysis of primary care patients' characteristics and physicians' adherence to guideline-directed medical therapy.
Observational study in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04129658 (Heart Failure in Southern Sweden - Improving the Quality of Diagnosis and Treatment Through a Educational Intervention in Primary Care), which is not on this map. Cited by 2 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Heart Failure in Southern Sweden - Improving the Quality of Diagnosis and Treatment Through a Educational Intervention in Primary Care
Who cites it
2 citing papers in PubMed.
- The Real-World Use of Guideline-Directed Medical Therapy in Patients with Heart Failure with Reduced Ejection Fraction Newly Initiated on Dapagliflozin: An EVOLUTION-HF CEE-BA Study (Results from the Baltic Cohort).Medicina (Kaunas, Lithuania) · 2026Article
- Iron deficiency in primary care patients with heart failure: a cross-sectional study of the heart failure in Southern Sweden (HISS) cohort.BMC cardiovascular disorders · 2026Article
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesWe aimed to describe clinical and diagnostic characteristics of primary care patients with heart failure and physicians' adherence to guideline-directed medical therapy (GDMT) for treating chronic heart failure.
designCross-sectional study based on baseline data from the prospective primary care-based study Heart failure in Southern Sweden (HISS).
settingPatients with heart failure were included from 20 primary healthcare centres in the southernmost region of Sweden (Skåne).
participantsBetween 2020 and 2023, patients were included in HISS, resulting in a total of 587 participants. Of these, 558 patients (95% of the HISS participants) had available data on left ventricular ejection fraction and were included in this study. Adult patients aged 18 years or older diagnosed with heart failure (International Classification of Diseases, 10th Revision codes I50, I11.0, I42, I43) were considered eligible for inclusion in HISS. Community-dwelling patients with assisted care were excluded. PRIMARY AND SECONDARY OUTCOMES: The primary outcome measures were distribution of heart failure subtypes and prescribed medications. The secondary outcomes were temporal trends in GDMT and the association between physicians' adherence to GDMT and clinical characteristics of patients, using logistic regression models.
resultsHeart failure with preserved ejection fraction (HFpEF) was the most prevalent subtype (42%), followed by mildly reduced (30%) and reduced ejection fraction (HFrEF, 28%). Among patients with HFrEF, 20% were prescribed the recommended GDMT according to the European Society of Cardiology (ESC) 2021 guidelines, which consisted of a renin-angiotensin system inhibitor, a beta-blocker, a mineralocorticoid receptor antagonist and a sodium-glucose 2 inhibitor. We observed no significant change in the prescribing trends for the quadruple therapy in patients with HFrEF when comparing the 2 years before and after the publication of the ESC 2021 guidelines. Similarly, we observed no association between patient characteristics and the prescription of GDMT according to ESC 2021 for patients with HFrEF.
conclusionHFpEF was the most prevalent subtype, with conclusive and recent echocardiography data among two-thirds of the cohort. Temporal trends in prescription patterns showed no appreciable increase in the use of GDMT for HFrEF during the two years following guideline publication compared with the two preceding years. These findings indicate a need for inclusion of primary care patients as a basis for intensified medical recommendations and implementation strategies. TRIAL REGISTRATION NUMBER: NCT04129658.
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