Use of disease-modifying therapies in patients hospitalized with heart failure: a population-based perspective.
BACKGROUND
Little data are available about the hospital management of patients with decompensated heart failure (HF) with individual and combination medical therapies, particularly from the more generalizable perspective of a population-based investigation. The purpose of our study was to describe the use of different cardiac medications in 2463 patients with new-onset HF who were discharged from all greater Worcester, Massachusetts, hospitals during 2000.


METHODS
On the basis of a review of medical records, we examined the prescribing of 2 classes of cardiac medications that have been shown to improve the long-term prognosis of patients with HF (angiotensin pathway inhibitors and beta-blockers). We also examined the use of 2 therapies commonly used to improve the symptomatic status of patients with acute HF (diuretics and digoxin).


RESULTS
The mean age of the study sample was 76 years, and 57% were women. Approximately 1 in 5 patients were not prescribed beta-blockers or angiotensin inhibitors during their index hospitalization, whereas 1 in 3 patients were discharged with both of these effective cardiac medications. Diuretics were prescribed for virtually all patients (98%), followed by the use of digoxin in approximately half of patients (48%). The receipt of both beta-blockers and angiotensin pathway inhibitors was associated with several demographic, medical history, and clinical factors. Patients treated with both effective cardiac medications were also more likely to be counseled to monitor or modify several lifestyle factors that have been shown to be effective adjuncts to the medical management of patients with HF.


CONCLUSIONS
Considerable opportunity remains for the more optimal hospital management of patients with decompensated HF.
Goldberg
Robert J
RJ
Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Mass, USA. Robert_Goldberg@brown.edu
Spencer
Frederick A
FA
Farmer
Cheryl
C
Lessard
Darleen
D
Pezzella
Stephen M
SM
Meyer
Theo E
TE
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000704:Analysis of Variance; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D008404:Massachusetts; D011379:Prognosis; D012189:Retrospective Studies
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004232:Diuretics