title: Incremental effects of concurrent pharmacotherapeutic regimens for heart failure on hospitalizations and costs.
abstract: BACKGROUND
  Inappropriate medication use in patients with heart failure (HF) presents challenges in providing optimal, evidence-based care.
  
  
  OBJECTIVE
  To evaluate the incremental differences of concurrent and persistent use of angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, loop diuretics, and digoxin on the one-year, all-cause risk of hospitalization and total healthcare costs associated with treatment of HF in patients enrolled in a managed care organization within the US.
  
  
  METHODS
  A retrospective database analysis was conducted spanning from January 1, 1997, to December 31, 1999. Multivariate regression methods were used to examine the association between treatment regimens and hospitalizations or costs after controlling for patient demographics and risk factors.
  
  
  RESULTS
  Of the 1903 patients meeting inclusion criteria, 32.3% (n = 615) received none of the 4 HF agents studied and were associated with a 2.5 times greater risk (p < or = 0.001) of hospitalization and 43.6% higher (p < or = 0.001) total costs compared with all other patients with HF. Comparatively, 13.9% (n = 264) utilized the HF medications investigated for at least 6 months. Of those with persistent use of > or =3 agents, approximate decreases in hospitalizations were noted of 80% (p < or = 0.001) and total costs of 70% (p < or = 0.001) relative to patients receiving no HF therapy.
  
  
  CONCLUSIONS
  A substantial portion of patients with HF may be receiving suboptimal pharmacotherapeutic care in real-world practice settings, potentially incurring large increases in hospitalizations and total costs. Quality improvement initiatives should seek to identify and manage those not being treated according to guideline recommendations.
authors.affiliation: College of Pharmacy, University of Arizona, Tucson, AZ 85721-0207, USA. skrepnek@pharmacy.arizona.edu
authors.forename: Grant H
authors.initials: GH
authors.lastname: Skrepnek
authors.forename: Jacob
authors.initials: J
authors.lastname: Abarca
authors.forename: Daniel C
authors.initials: DC
authors.lastname: Malone
authors.forename: Edward P
authors.initials: EP
authors.lastname: Armstrong
authors.forename: Farshad M
authors.initials: FM
authors.lastname: Shirazi
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Woosley
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use; D002908:Chronic Disease; D003365:Costs and Cost Analysis; D004077:Digoxin / Q000191:economics / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000191:economics / Q000706:statistics & numerical data; D017723:Drug Utilization Review / Q000191:economics / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy*; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration; D015999:Multivariate Analysis; D012307:Risk Factors; D049994:Sodium Potassium Chloride Symporter Inhibitors / Q000191:economics / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D049994:Sodium Potassium Chloride Symporter Inhibitors; D004077:Digoxin