title: Prescription of cardiovascular drugs in the French ODIN cohort of heart failure patients according to age and type of chronic heart failure.
abstract: BACKGROUND
  Chronic heart failure (CHF) is a frequent severe disease. Disease-management programmes, which contain a therapeutic patient education component, will play a central role in improving delivery of care and reducing mortality and hospitalizations for CHF.
  
  
  OBJECTIVE
  In order to have an up-to-date overview of medical treatment of CHF in France implemented by hospital and clinic cardiologists especially interested in CHF and therapeutic patient education, we described the prescription of cardiovascular drugs in the large ODIN cohort of CHF patients, according to age and type of CHF.
  
  
  METHODS
  From 2007 to 2010 (median follow-up 27.2 months), CHF patients were prospectively enrolled in a multicentre 'real-world' French cohort by centres previously trained in therapeutic patient education. Patients were grouped according to age (< 60 years, 60 to<70 years, 70 to<80 years and ≥ 80 years) and type of CHF (characterized by level of LVEF: reduced, borderline or preserved). Medical prescription was described and mortality was assessed at long-term follow-up.
  
  
  RESULTS
  The cohort consisted of 3237 patients (67.6 years; 69.4% men). The oldest age group had the highest LVEF. Blockers of the angiotensin-aldosterone system were prescribed progressively and significantly less frequently as the population advanced in age or as LVEF was more preserved. The mean dosages of the main prescribed CHF drugs remained ≥ 50% lower than those recommended for most drugs in all age and LVEF groups. Drug prescriptions were related to aetiology of reduced or preserved CHF. A global decrease in CHF drug prescription was observed for all medication classes except calcium blockers, according to maintenance of relatively or totally preserved LVEF. Survival was related to age but not to type of CHF.
  
  
  CONCLUSIONS
  In CHF, and despite management by cardiologists particularly interested in CHF and specifically trained to deliver therapeutic patient education, medical prescription differed substantially from guidelines. Age and type of CHF (reduced versus preserved) appeared to be important factors in lack of adherence to guidelines. However, only age influenced mortality; the type of CHF did not affect survival.
authors.affiliation: Cardiology Department, institut Lorrain du coeur et des vaisseaux, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France. Electronic address: y.juilliere@chu-nancy.fr.
authors.forename: Yves
authors.initials: Y
authors.lastname: Juillière
authors.affiliation: Cardiology Department, institut Lorrain du coeur et des vaisseaux, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Suty-Selton
authors.affiliation: Cardiology Department, institut Lorrain du coeur et des vaisseaux, allée du Morvan, 54500 Vandœuvre-lès-Nancy, France.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Riant
authors.affiliation: Cardiology, CHG Samuel-Pozzi, Bergerac, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Darracq
authors.affiliation: Cardiology, CHG William-Morey, Chalon-sur-Saône, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Dellinger
authors.affiliation: Cardiology, clinique Château-de-Vernhes, Bondigoux, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Labarre
authors.affiliation: URC-Est, CHU Saint-Antoine, Paris, France.
authors.forename: Justine
authors.initials: J
authors.lastname: Druelle
authors.affiliation: French Society of Cardiology, Paris, France.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Mulak
authors.affiliation: Cardiology, European Hospital Georges Pompidou, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
authors.affiliation: Cardiology, CHG René-Dubos, Pontoise, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Jourdain
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002908:Chronic Disease; D011307:Drug Prescriptions / Q000592:standards; D017723:Drug Utilization Review; D005260:Female; D005602:France; D019983:Guideline Adherence; D006333:Heart Failure / Q000145:classification / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D012042:Registries; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D002317:Cardiovascular Agents
keywords: Age; Cardiovascular drugs; Fraction d’éjection ventriculaire gauche; Heart failure with preserved ejection fraction; Insuffisance cardiaque avec fraction d’éjection préservée; Insuffisance cardiaque systolique; Left ventricular ejection fraction; Médicaments cardiovasculaires; Systolic heart failure; Âge