title: Trends in the medical management of patients with heart failure.
abstract: BACKGROUND
  Despite the availability of effective therapies, heart failure (HF) remains a highly prevalent disease and the leading cause of hospitalizations in the U.S. Few data are available, however, describing changing trends in the use of various cardiac medications to treat patients with HF and factors associated with treatment. The objectives of this population-based study were to examine decade-long trends (1995 - 2004) in the use of several cardiac medications in patients hospitalized with acute decompensated heart failure (ADHF) and factors associated with evidence-based treatment.
  
  
  METHODS
  We reviewed the medical records of 9,748 residents of the Worcester, MA, metropolitan area who were hospitalized with ADHF at all 11 central Massachusetts medical centers in 1995, 2000, 2002, and 2004.
  
  
  RESULTS
  Between 1995 and 2004, respectively, the prescription upon hospital discharge of beta-blockers (23%; 67%), angiotensin pathway inhibitors (47%; 55%), statins (5%; 43%), and aspirin (35%; 51%) increased markedly, while the use of digoxin (51%; 29%), nitrates (46%; 24%), and calcium channel blockers (33%; 22%) declined significantly; nearly all patients received diuretics. Patients in the earliest study year, those with a history of obstructive pulmonary disease or anemia, incident HF, non-specific symptoms, and women were less likely to receive beta blockers and angiotensin pathway inhibitors than respective comparison groups. In 2004, 82% of patients were discharged on at least one of these recommended agents; however, only 41% were discharged on medications from both recommended classes.
  
  
  CONCLUSIONS
  Our data suggest that opportunities exist to further improve the use of HF therapeutics.
authors.affiliation: Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA ; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
authors.forename: Samuel W
authors.initials: SW
authors.lastname: Joffe
authors.forename: Matthew
authors.initials: M
authors.lastname: Dewolf
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Shih
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Spencer
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
keywords: Acute heart failure; Population surveillance; Time trends