Changes in heart failure medications in patients hospitalised and discharged.
BACKGROUND
To date, evidence-based recommendations help doctors to manage patients with heart failure (HF). However, the implementation of these recommendations in primary care is still problematic as beneficial drugs are infrequently prescribed. The aim of the study was to determine whether admission to hospital increases usage of beneficial HF medication and if this usage is maintained directly after discharge.


METHODS
The study was conducted from November 2002 until January 2004. In 77 patients hospitalised with heart failure (HF), the medication prescribed by the referring general practitioner (GP) and drug treatment directed by the hospital physicians was documented. Information regarding the post-discharge (14 d) therapy by the GP was evaluated via a telephone interview. Ejection fraction values, comorbidity and specifics regarding diagnostic or therapeutic intervention were collected by chart review.


RESULTS
When compared to the referring GPs, hospital physicians prescribed more ACE-inhibitors (58.4% vs. 76.6%; p = 0.001) and beta-blockers of proven efficacy in HF (metoprolol, bisoprolol, carvedilol; 58.4% vs. 81.8%). Aldosterone antagonists were also administered more frequently in the hospital setting compared to general practice (14.3% vs. 37.7%). The New York Heart Association classification for heart failure did not influence whether aldosterone antagonists were administered either in primary or secondary care. Fourteen days after discharge, there was no significant discontinuity in discharge medication.


CONCLUSIONS
Patients suffering from HF were more likely to receive beneficial medication in hospital than prior to admission. The treatment regime then remained stable two weeks after discharge. We suggest that findings on drug continuation in different cardiovascular patients might be considered validated for patients with HF.
Scherer
Martin
M
Department of General Practice, University of Göttingen, Humboldtallee 38, 37073 Göttingen, Germany. mschere@gwdg.de
Sobek
Cordula
C
Wetzel
Dirk
D
Koschack
Janka
J
Kochen
Michael M
MM
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000359:Aftercare / Q000592:standards*; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000145:classification / Q000627:therapeutic use*; D017723:Drug Utilization Review; D005194:Family Practice / Q000592:standards*; D005260:Female; D005858:Germany; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000592:standards*; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation / Q000592:standards
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents; D000451:Mineralocorticoid Receptor Antagonists