[Medical treatment of heart failure: an analysis of actual treatment practices in outpatients in Switzerland. The Swiss "IMPROVEMENT of HF" Group].
BACKGROUND
From several studies in Europe and the USA there is evidence that drug treatment of patients with congestive heart failure (CHF) could be improved. There are only sparse data on the treatment of this population in Switzerland.


METHODS
In the context of a European Study (IMPROVEMENT of HF Study), in 1999, the treatment of 474 patients with symptomatic CHF was recorded by chart review with primary care physicians throughout Switzerland. The effect of potential predictors of drug treatment was tested using multivariate logistic regression.


RESULTS
Mean age of the study population was 75 +/- 12 years. Overall, angiotensin-converting enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARB) were prescribed to 65% of the study population. Beta-blockers, loop diuretics/thiazides, spironolactone and digitalis were prescribed to 25%, 73%, 13% and 31% respectively. Compared with CHF patients < 65 years of age, the odds ratio of ACE-I/ARB prescription in patients aged 65-74, 75-84, and > or = 85 years was 0.80, 0.58 and 0.40 respectively (p < 0.001). The respective odds ratios for beta blocker treatment were 0.37, 0.21 and 0.06 (p < 0.001). In addition, NYHA classification, comorbid conditions such as renal failure and contraindications strongly predicted drug prescription. Gender and geographical area were not associated with drug selection.


CONCLUSIONS
Overall drug prescription among CHF patients in Swiss primary care appears to be satisfactory. However, prescription of ACE-I/ARB and beta-blockers falls steeply with increasing age, independent of measured comorbid conditions and contraindications. Thus, improvement of treatment should focus on a more consistent use of these drugs in the segment of elderly CHF patients.
Muntwyler
J
J
Departement Innere Medizin, Medizinische Klinik A, Universitätsspital Zürich. joerg.muntwyler@DIM.usz.ch
Follath
F
F
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004071:Digitalis Glycosides / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D005060:Europe; D005260:Female; D006333:Heart Failure / Q000145:classification / Q000188:drug therapy*; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D013148:Spironolactone / Q000627:therapeutic use; D013557:Switzerland
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D004071:Digitalis Glycosides; D004232:Diuretics; D013148:Spironolactone