Treatment of chronic heart failure in a managed care setting. Baseline results from the Achieving Cardiac Excellence Project.
BACKGROUND
Effective therapy for chronic heart failure (CHF) is underutilized despite a broad consensus regarding treatment recommendations.


METHODS
As a quality improvement project designed to reduce preventable hospitalizations associated with CHF, we examined use of angiotensin converting enzyme inhibitors (ACEI), angiotensin receptor blockers (ARB), and beta-adrenergic receptor blockers (BB) in a population of patients enrolled in a managed care plan. Medicare and commercial enrollees were included. Patients with CHF were identified using claims data (International Classification of Disease 9th Clinical Modification code 428) covering January 1, 1998 through December 31, 1998. Drug utilization data were obtained from the plan's pharmacy benefits database. Data were available for 1220 patients.


RESULTS
The mean age (+/- SD) was 71 +/- 12 years, 53% were female, and 84% were Medicare enrollees. Prescriptions for ACEI, ARB and BB were filled by 52%, 9% and 25% of patients, respectively. Prescriptions for diuretics, digitalis preparations, and calcium channel blockers (CCB) were filled by 69%, 34%, and 32%, respectively. Therefore, almost half of patients with CHF were not receiving ACEI therapy, even though it had been proven to reduce morbidity and mortality related to CHF. Furthermore, three-quarters of patients were not receiving BB therapy, a similarly effective therapy. In contrast, CCB and digitalis have not been convincingly shown to reduce mortality in patients with CHF broadly defined. Utilization of CCB and digitalis exceeded that of BB.


CONCLUSIONS
Managed care organizations should develop, test, and implement network-level strategies designed to optimize the appropriate utilization of effective drug therapies for patients with CHF.
Schmedtje
John F
JF
Wake Forest University School of Medicine, Winston-Salem, USA. john.schmedtje@worldnet.att.net
Evans
Gregory W
GW
Byerly
Wesley
W
King
Mark
M
Goonan
Kelly
K
Blastock-Glenn
Camille
C
Croft
Janet B
JB
Goff
David C
DC
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002908:Chronic Disease; D017723:Drug Utilization Review; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008329:Managed Care Programs / Q000592:standards*; D008875:Middle Aged; D015999:Multivariate Analysis; D009657:North Carolina; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors