title: Time-trends in treatment and cardiovascular events in patients with heart failure: a pharmacosurveillance study.
abstract: OBJECTIVE
  We assessed, in patients with a first hospitalization for heart failure (HF), the temporal relationship of the incidence of cardiovascular events, all-cause mortality, and cardiovascular drug treatment.
  
  
  RESULTS
  Data were obtained from the PHARMO Record Linkage System, a population-based registry of pharmacy records linked with hospital discharge records in The Netherlands. Patients were selected based on a first hospital discharge diagnosis of documented HF. Two time-periods were compared: 1998-2002 and 2003-07. In each time-period, we analysed all prescribed cardiovascular medications, all-cause mortality, and cardiovascular events (rehospitalization for HF and ischaemic events) within the first year after hospitalization, and the occurrence of ischaemic events separately (myocardial infarction and ischaemic stroke). Cox-regression analysis was performed to calculate hazard ratios (HR) with 95% confidence intervals (CI). We identified 8276 patients in 1998-2002 and 9548 patients from 2003-07. There was an increase in almost all cardiovascular medication prescriptions in the second period: in particular, beta-blocker prescriptions rose from 36% in 1998-2002 to 55% in 2003-07. In the first year after hospitalization, there was no difference in all-cause mortality or any cardiovascular event (HR 1.00, 95%CI: 0.95-1.05), as a composite endpoint or when analysed separately. The incidence of ischaemic events decreased from 2.7 to 1.9% in the first and second time-period, respectively (HR 0.74, 95%CI: 0.61-0.90).
  
  
  CONCLUSIONS
  Prescription of cardiovascular medications in patients with a first hospitalization for HF has increased in recent years, particularly for beta-blockers, and the incidence of ischaemic events may have decreased. There was no decrease in all-cause mortality or cardiovascular events.
authors.affiliation: Department of Vascular Medicine, Academic Medical Centre, Amsterdam, The Netherlands. o.r.depeuter@amc.uva.nl
authors.forename: Olav R
authors.initials: OR
authors.lastname: de Peuter
authors.forename: Gregory Y H
authors.initials: GY
authors.lastname: Lip
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Souverein
authors.forename: Olaf H
authors.initials: OH
authors.lastname: Klungel
authors.forename: Anthonius
authors.initials: A
authors.lastname: de Boer
authors.forename: Harry R
authors.initials: HR
authors.lastname: Büller
authors.forename: Pieter W
authors.initials: PW
authors.lastname: Kamphuisen
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000150:complications; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use; D004077:Digoxin / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications; D017202:Myocardial Ischemia / Q000150:complications; D010818:Practice Patterns, Physicians' / Q000639:trends*; D011379:Prognosis; D013148:Spironolactone / Q000627:therapeutic use; D020521:Stroke / Q000150:complications
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002316:Cardiotonic Agents; D004232:Diuretics; D013148:Spironolactone; D004077:Digoxin