title: Disparity of physician specialties in the management of chronic heart failure: trend analysis in Taiwan, 2000 - 2010.
abstract: OBJECTIVE
  Chronic heart failure (CHF) is a condition that is daily confronted by clinicians in a variety of medical specialties, where physicians routinely seek optimum pharmacotherapy for their outpatients with CHF. We conducted a population- based study on pharmacotherapy for outpatients with CHF in Taiwan from 2000 to 2010, which focused on drug prescription patterns of different physician specialties.
  
  
  METHODS
  We retrieved records from the National Health Insurance Research Database of patient ambulatory visits with diagnosed chronic heart failure, when cardiovascular drugs were prescribed. For purposes of this study, anti-chronic heart failure drugs were separated into categories: mortality reducing agents (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, spironolactone, hydralazine plus nitrates) and symptom-relieving agents (digoxin, diuretics). Thereafter, the trends of prescription patterns related to different physician specialties were analyzed.
  
  
  RESULTS
  From 2000 to 2010, the prescription rate of any mortality-reducing agent for CHF outpatients rose from 61.5% to 76.3% while the concomitant rate for digoxin decreased from 47.3% to 45.4%. Compared to internists and family physicians, cardiologists not only prescribed far more mortality-reducing agents from 2000 to 2010 (53.9 - 72.7%, 54.1 - 64.3%, 74.7 - 84.4%, respectively), but also prescribed two or three mortality-reducing drugs.
  
  
  CONCLUSIONS
  There was a significant improvement of optimal pharmacotherapy for chronic heart failure in Taiwan. We observed that cardiologists were more aggressive than non-cardiologists when deciding whether to prescribe mortality-reducing drugs for heart failure management. However, those factors which influence the prescription patterns of internists and family physicians for their patients with CHF still require additional research.
authors.affiliation: Department of Critical Care Medicine, Taipei Veterans General Hospital, Taiwan.
authors.forename: Chia-Yu
authors.initials: CY
authors.lastname: Chou
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.forename: Shu-Chiung
authors.initials: SC
authors.lastname: Chiang
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Chen
authors.forename: Ming-Hui
authors.initials: MH
authors.lastname: Cheng
authors.forename: Yao-Chia
authors.initials: YC
authors.lastname: Yang
authors.forename: Cheng-Hsueh
authors.initials: CH
authors.lastname: Wu
authors.forename: Chin-Chin
authors.initials: CC
authors.lastname: Ho
authors.forename: Yu-Ju
authors.initials: YJ
authors.lastname: Huang
authors.forename: Yueh-Ching
authors.initials: YC
authors.lastname: Chou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D004077:Digoxin / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D010818:Practice Patterns, Physicians'; D013038:Specialization; D013624:Taiwan; D013997:Time Factors
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D004077:Digoxin