Use of guideline-recommended therapies for heart failure in the Medicare population.
BACKGROUND
Most information about the use of guideline-recommended therapies for heart failure reflects what occurred at discharge after an inpatient stay.


OBJECTIVE
Using a nationally representative, community-dwelling sample of elderly Medicare beneficiaries, we examined how the use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and beta-blockers has changed and factors associated with their use.


METHODS
Using data from the Medicare Current Beneficiary Survey cost and use files matched with Medicare claims data, we identified beneficiaries for whom a diagnosis of heart failure was reported between January 1, 2000, and December 31, 2004. Data on medications prescribed during the year of cohort entry were based on patient self-report. We used multivariable logistic regression to explore relationships between the use of ACE inhibitors/ARBs and beta-blockers and patient demographic characteristics.


RESULTS
From 2000 through 2004, the use of ARBs increased from 12% to 19%, and the use of beta-blockers increased from 30% to 41%. The use of ACE inhibitors remained constant at 45%. Beneficiaries who reported having prescription drug insurance coverage were 32% more likely than other beneficiaries to have filled a prescription for an ACE inhibitor or ARB and 26% more likely to have filled a prescription for a beta-blocker.


CONCLUSIONS
Although the use of guideline-recommended therapies for heart failure has increased, it remains suboptimal.
DiMartino
Lisa D
LD
Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina 27715, USA.
Shea
Alisa M
AM
Hernandez
Adrian F
AF
Curtis
Lesley H
LH
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents