title: Utilization of evidence-based treatment in elderly patients with chronic heart failure: using Korean Health Insurance claims database.
abstract: BACKGROUND
  Chronic heart failure accounts for a great deal of the morbidity and mortality in the aging population. Evidence-based treatments include angiotensin-2 receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACE-I), beta-blockers, and aldosterone antagonists. Underutilization of these treatments in heart failure patients were frequently reported, which could lead to increase morbidity and mortality. The aim of this study was to evaluate the utilization of evidence-based treatments and their related factors for elderly patients with chronic heart failure.
  
  
  METHODS
  This is retrospective observational study using the Korean National Health Insurance claims database. We identified prescription of evidence based treatment to elderly patients who had been hospitalized for chronic heart failure between January 1, 2005, and June 30, 2006.
  
  
  RESULTS
  Among the 28,922 elderly patients with chronic heart failure, beta-blockers were prescribed to 31.5%, and ACE-I or ARBs were prescribed to 54.7% of the total population. Multivariable logistic regression analyses revealed that the prescription from outpatient clinic (prevalent ratio, 4.02, 95% CI 3.31-4.72), specialty of the healthcare providers (prevalent ratio, 1.26, 95% CI, 1.12-1.54), residence in urban (prevalent ratio, 1.37, 95% CI, 1.23-1.52) and admission to tertiary hospital (prevalent ratio, 2.07, 95% CI, 1.85-2.31) were important factors associated with treatment underutilization. Patients not given evidence-based treatment were more likely to experience dementia, reside in rural areas, and have less-specialized healthcare providers and were less likely to have coexisting cardiovascular diseases or concomitant medications than patients in the evidence-based treatment group.
  
  
  CONCLUSIONS
  Healthcare system factors, such as hospital type, healthcare provider factors, such as specialty, and patient factors, such as comorbid cardiovascular disease, systemic disease with concomitant medications, together influence the underutilization of evidence-based pharmacologic treatment for patients with heart failure.
authors: Department of Family Medicine, Seoul National University Bundang Hospital, Seoul, Korea.
authors: Ju-Young
authors: JY
authors: Kim
authors: Hwa-Jung
authors: HJ
authors: Kim
authors: Sun-Young
authors: SY
authors: Jung
authors: Kwang-Il
authors: KI
authors: Kim
authors: Hong Ji
authors: HJ
authors: Song
authors: Joong-Yub
authors: JY
authors: Lee
authors: Jong-Mi
authors: JM
authors: Seong
authors: Byung-Joo
authors: BJ
authors: Park
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002908:Chronic Disease; D015897:Comorbidity; D016208:Databases, Factual / Q000706:statistics & numerical data; D004363:Drug Utilization; D017723:Drug Utilization Review; D019317:Evidence-Based Medicine / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D018579:Patient Selection; D019338:Polypharmacy; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies
chemical_list: D002317:Cardiovascular Agents