title: The relevance of comorbidities for heart failure treatment in primary care: A European survey.
abstract: OBJECTIVE
  To assess the impact of comorbidities on chronic heart failure (CHF) therapy.
  
  
  METHODS
  The IMPROVEMENT-HF survey included 11,062 patients from 100 primary care practices in 14 European countries. The influence of patient characteristics on drug regimes was assessed with multinomial logistical regression.
  
  
  RESULTS
  Combined drug regimes were given to 48% of CHF patients, consisting of 2.2 drugs on average. Patient characteristics accounted for 35%, 42% and 10% of the variance in one-, two- and three-drug regimes, respectively. Myocardial infarction (MI), atrial fibrillation (AF), diabetes, hypertension, and lung disease influenced prescribing most. AF made all combinations containing beta-blockers more likely. Thus for single drug regimes, MI increased the likelihood for non-recommended beta-blocker monotherapy (OR 1.3; 95% CI 1.2-1.4), while for combination therapy recommended regimes were most likely. For both hypertension and diabetes, ACE-inhibitors were the most likely single drug, while the most likely second drugs were beta-blockers in hypertension and digoxin in diabetes.
  
  
  CONCLUSIONS
  Patient characteristics have a clear impact on prescribing in European primary care. Up to 56% of drug regimes were rational taking patient characteristics into account. Situations of insufficient prescribing, such as patients post MI, need to be addressed specifically.
authors.affiliation: Department of Clinical Pharmacology, University Medical Center Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands. h.sturm@med.umcg.nl
authors.forename: Heidrun B
authors.initials: HB
authors.lastname: Sturm
authors.forename: Flora M
authors.initials: FM
authors.lastname: Haaijer-Ruskamp
authors.forename: Nic J
authors.initials: NJ
authors.lastname: Veeger
authors.forename: Corine P
authors.initials: CP
authors.lastname: Baljé-Volkers
authors.forename: Karl
authors.initials: K
authors.lastname: Swedberg
authors.forename: Wiek H
authors.initials: WH
authors.lastname: van Gilst
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D015897:Comorbidity; D011307:Drug Prescriptions; D005060:Europe / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D011159:Population Surveillance; D011320:Primary Health Care / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists