Pharmacologic management of heart failure among older adults by office-based physicians in the United States.
BACKGROUND
Despite the recent availability of new classes of heart failure medications, little is known about national patterns in the actual physician utilization of these drugs.


METHODS
In the National Ambulatory Medical Care Survey, 2912 US physicians reported on 16,968 office visits in 1991-1992 with patients aged > or = 65 years. National estimates were obtained from weighted results that accounted for the complex sampling design.


RESULTS
An estimated 8.3 million (2.6%) office visits with older adults involved heart failure. This included 9.3% of visits to cardiologists, 4.3% to internists, 3.5% to general and family physicians, and 0.6% to other physicians. The most frequently prescribed medications during visits with these patients were diuretics (69%), digitalis compounds (46%), angiotensin-converting enzyme inhibitors (30%), and nitrates (19%). Internists and general and family physicians prescribed angiotensin-converting enzyme inhibitors, digitalis compounds, and loop diuretics for patients with heart failure less often than did cardiologists.


CONCLUSIONS
These are the first national surveillance estimates of physician practices in the management of heart failure. These data were collected during the same period in which heart failure clinical trial results were initially published, and they provide a baseline for monitoring the influence of recent clinical practice guidelines and professional education on changes in the management of heart failure by primary care physicians.
Croft
J B
JB
National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia 30341-3724, USA.
Giles
W H
WH
Roegner
R H
RH
Anda
R F
RF
Casper
M L
ML
Livengood
J R
JR
D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002303:Cardiac Output, Low / Q000188:drug therapy*; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D004071:Digitalis Glycosides / Q000627:therapeutic use*; D004232:Diuretics / Q000627:therapeutic use*; D004363:Drug Utilization; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D009819:Office Visits; D010818:Practice Patterns, Physicians'; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy
D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D004071:Digitalis Glycosides; D004232:Diuretics