title: Outpatient management of heart failure in the United States, 2006-2008.
abstract: Better outpatient management of heart failure might improve outcomes and reduce the number of rehospitalizations. This study describes recent outpatient heart-failure management in the United States. We analyzed data from the National Ambulatory Medical Care Survey of 2006-2008, a multistage random sampling of non-Federal physician offices and hospital outpatient departments. Annually, 1.7% of all outpatient visits were for heart failure (51% females and 77% non-Hispanic whites; mean age, 73 ± 0.5 yr). Typical comorbidities were hypertension (62%), hyperlipidemia (36%), diabetes mellitus (35%), and ischemic heart disease (29%). Body weight and blood pressure were recorded in about 80% of visits, and health education was given in about 40%. The percentage of patients taking β-blockers was 38%; the percentage taking angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) was 32%. Medication usage did not differ significantly by race or sex. In multivariate-adjusted logistic regression models, a visit to a cardiologist, hypertension, heart failure as a primary reason for the visit, and a visit duration longer than 15 minutes were positively associated with ACEI/ARB use; and a visit to a cardiologist, heart failure as a primary reason for the visit, the presence of ischemic heart disease, and visit duration longer than 15 minutes were positively associated with β-blocker use. Chronic obstructive pulmonary disease was negatively associated with β-blocker use. Approximately 1% of heart-failure visits resulted in hospitalization. In outpatient heart-failure management, gaps that might warrant attention include suboptimal health education and low usage rates of medications, specifically ACEI/ARBs and β-blockers.
authors: Departments of Internal Medicine (Dr. Mosalpuria) and Cardiology (Dr. Pierre-Louis), Harlem Hospital Center affiliated with Columbia University, New York, New York 10037; Department of Medicine (Drs. Agarwal and Russell), Johns Hopkins University, Baltimore; Maryland 21205; Department of Epidemiology (Dr. Yaemsiri), University of North Carolina, Chapel Hill, North Carolina 27599; and Cardiovascular Institute (Drs. Agarwal, Alvarez, and Saba), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213.
authors: Kailash
authors: K
authors: Mosalpuria
authors: Departments of Internal Medicine (Dr. Mosalpuria) and Cardiology (Dr. Pierre-Louis), Harlem Hospital Center affiliated with Columbia University, New York, New York 10037; Department of Medicine (Drs. Agarwal and Russell), Johns Hopkins University, Baltimore; Maryland 21205; Department of Epidemiology (Dr. Yaemsiri), University of North Carolina, Chapel Hill, North Carolina 27599; and Cardiovascular Institute (Drs. Agarwal, Alvarez, and Saba), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213.
authors: Sunil K
authors: SK
authors: Agarwal
authors: Departments of Internal Medicine (Dr. Mosalpuria) and Cardiology (Dr. Pierre-Louis), Harlem Hospital Center affiliated with Columbia University, New York, New York 10037; Department of Medicine (Drs. Agarwal and Russell), Johns Hopkins University, Baltimore; Maryland 21205; Department of Epidemiology (Dr. Yaemsiri), University of North Carolina, Chapel Hill, North Carolina 27599; and Cardiovascular Institute (Drs. Agarwal, Alvarez, and Saba), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213.
authors: Sirin
authors: S
authors: Yaemsiri
authors: Departments of Internal Medicine (Dr. Mosalpuria) and Cardiology (Dr. Pierre-Louis), Harlem Hospital Center affiliated with Columbia University, New York, New York 10037; Department of Medicine (Drs. Agarwal and Russell), Johns Hopkins University, Baltimore; Maryland 21205; Department of Epidemiology (Dr. Yaemsiri), University of North Carolina, Chapel Hill, North Carolina 27599; and Cardiovascular Institute (Drs. Agarwal, Alvarez, and Saba), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213.
authors: Bredy
authors: B
authors: Pierre-Louis
authors: Departments of Internal Medicine (Dr. Mosalpuria) and Cardiology (Dr. Pierre-Louis), Harlem Hospital Center affiliated with Columbia University, New York, New York 10037; Department of Medicine (Drs. Agarwal and Russell), Johns Hopkins University, Baltimore; Maryland 21205; Department of Epidemiology (Dr. Yaemsiri), University of North Carolina, Chapel Hill, North Carolina 27599; and Cardiovascular Institute (Drs. Agarwal, Alvarez, and Saba), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213.
authors: Samir
authors: S
authors: Saba
authors: Departments of Internal Medicine (Dr. Mosalpuria) and Cardiology (Dr. Pierre-Louis), Harlem Hospital Center affiliated with Columbia University, New York, New York 10037; Department of Medicine (Drs. Agarwal and Russell), Johns Hopkins University, Baltimore; Maryland 21205; Department of Epidemiology (Dr. Yaemsiri), University of North Carolina, Chapel Hill, North Carolina 27599; and Cardiovascular Institute (Drs. Agarwal, Alvarez, and Saba), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213.
authors: Rene
authors: R
authors: Alvarez
authors: Departments of Internal Medicine (Dr. Mosalpuria) and Cardiology (Dr. Pierre-Louis), Harlem Hospital Center affiliated with Columbia University, New York, New York 10037; Department of Medicine (Drs. Agarwal and Russell), Johns Hopkins University, Baltimore; Maryland 21205; Department of Epidemiology (Dr. Yaemsiri), University of North Carolina, Chapel Hill, North Carolina 27599; and Cardiovascular Institute (Drs. Agarwal, Alvarez, and Saba), University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213.
authors: Stuart D
authors: SD
authors: Russell
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D015897:Comorbidity; D017723:Drug Utilization Review; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D009819:Office Visits / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents
keywords: Ambulatory care/standards; cardiovascular agents/therapeutic use; clinical trials as topic; comprehensive health care; drug utilization/statistics & numerical data; health care surveys; heart failure/drug therapy/economics/epidemiology/prevention & control; office visits/statistics & numerical data/trends/utilization; outcome assessment (health care)/trends; quality assurance, health care