title: Prescription in patients with chronic heart failure and multimorbidity attended in primary care.
abstract: BACKGROUND
  Multimorbidity and polypharmacy pose challenges to improving the quality of care.
  
  
  OBJECTIVE
  To determine the association between prescription of recommended treatment in ambulatory patients with chronic heart failure and multiple comorbidities and hospitalisation events.
  
  
  METHODS
  A population-based retrospective cohort study in Catalonia (north-east Spain).
  
  
  METHODS
  We included 7173 newly registered patients with chronic heart failure (59% women; mean [SD] age 76.3 [10.7] years). Patients were selected from the electronic patient records of primary care practices and followed for three years.
  
  
  METHODS
  Prescription of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs) and beta-blockers (BBs).
  
  
  RESULTS
  Prescription of ACEI/ARBs in patients managed in primary care without a hospitalisation event during the follow-up rose from 50.8 to 83.5% for 0 and ≥4 comorbidities, respectively, and for ACEI/ARBs and BB from 13.1 to 30.6% for 0 and ≥4 comorbidities respectively. Patients with a hospitalisation event were treated more often (ACEI/ARBs or 1.47 [1.17 to 1.85]; ACEI/ARBs and BB or 1.41 [1.17 to 1.69]). Comorbid conditions receiving more treatment were hypertension (ACEI/ARBs or 3.75 [3.33 to 4.22]; ACEI/ARBs and BB or 1.40 [1.23 to 1.59]), diabetes mellitus (ACEI/ARBs or 1.79 [1.57 to 2.04]; ACEI/ARBs and BB or 1.33 [1.18 to 1.49]) and ischaemic heart disease (ACEI/ARBs or 1.25 [1.10 to 1.42]; ACEI/ARBs and BB or 3.01 [2.68 to 3.38]).
  
  
  CONCLUSIONS
  Prescription of recommended treatment in patients with chronic heart failure increased as the number of comorbidities increased. Family physicians can provide equivalent care to more complex patients and those less complex, according to the number of comorbidities.
authors.affiliation: Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, The Netherlands; Instituto Universitario Avedis Donabedian, Spain; Universitat Autònoma de Barcelona, Spain; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain; C/ Provença 293, pral. 08037 Barcelona, Spain. eva.frigola@gmail.com.
authors.forename: Eva
authors.initials: E
authors.lastname: Frigola-Capell
authors.forename: Jose M
authors.initials: JM
authors.lastname: Verdú-Rotellar
authors.forename: Josep
authors.initials: J
authors.lastname: Comin-Colet
authors.forename: Josep
authors.initials: J
authors.lastname: Davins-Miralles
authors.forename: Eduardo
authors.initials: E
authors.lastname: Hermosilla
authors.forename: Michel
authors.initials: M
authors.lastname: Wensing
authors.forename: Rosa
authors.initials: R
authors.lastname: Suñol
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002908:Chronic Disease; D015897:Comorbidity; D004363:Drug Utilization; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012189:Retrospective Studies; D012737:Sex Factors; D013030:Spain
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents