title: Prevalence of Heart Failure and Adherence to Process Indicators: Which Socio-Demographic Determinants are Involved?
abstract: Interest in chronic conditions reflects their role as the first cause of death and disability in developed countries; improving the management of these conditions is a priority for health care services. The aim of this study was to establish which sociodemographic factors influence adherence to standards of care for chronic heart failure (CHF). A generalized multilevel structural equation model was developed and applied to a sample of patients with CHF obtained from administrative data flows in six Italian regions to ascertain any associations between adherence to standards of care for CHF and sociodemographic variables. Indicators of compliance were adherence to beta-blocker therapy (BB-A) and Angiotensin Convertin Enzime inhibitor/Angiotensin Receptor Blocker therapy (ACE-A), and creatinine and electrolyte testing (CNK-T). All indicators were computed over a one-year follow-up. Among a cohort of 24,997 patients, the BB-A rate was 40.4%, the ACE-A rate 61.1%, and the CNK-T rate 57.0%. Factors found associated with adherence were gender, age, and citizenship. Our study shows an inadequate adherence to standards of care for CHF, particularly associated with certain sociodemographic characteristics. This suggests the need to improve the role of primary care in managing this chronic condition. The measures considered only apply to patients with a reduced Left Ventricular Ejection Fraction, hence a limitation of this analysis is the lack of information on left ventricular ejection.
authors.affiliation: Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padova, 35122 Padova, Italy. alessandra.buja@unipd.it.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Buja
authors.affiliation: Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy. gsolinas@uniss.it.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Solinas
authors.affiliation: Agenas, National Agency for Health Services, 00187 Rome, Italy. visca@agenas.it.
authors.forename: Modesta
authors.initials: M
authors.lastname: Visca
authors.affiliation: Department of Human Sciences, Social and Health, University of Cassino and Southern Lazio, 03043 Cassino, Italy. b.federico@unicas.it.
authors.forename: Bruno
authors.initials: B
authors.lastname: Federico
authors.affiliation: Regional Health Agency of Tuscany, 50141 Firenze, Italy. rosa.gini@ars.toscana.it.
authors.forename: Rosa
authors.initials: R
authors.lastname: Gini
authors.affiliation: Laboratory of Public Health and Population Studies, Department of Molecular Medicine, University of Padova, 35122 Padova, Italy. vincenzo.baldo@unipd.it.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Baldo
authors.affiliation: Regional Health Agency of Tuscany, 50141 Firenze, Italy. paolo.francesconi@ars.toscana.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Francesconi
authors.affiliation: Faculty of Medicine, University of Padova, 35122 Padova, Italy. gino.sartor@studenti.unipd.it.
authors.forename: Gino
authors.initials: G
authors.lastname: Sartor
authors.affiliation: Agenas, National Agency for Health Services, 00187 Rome, Italy. bellentani@agenas.it.
authors.forename: Mariadonata
authors.initials: M
authors.lastname: Bellentani
authors.affiliation: Department of Public Health, Università Cattolica del Sacro Cuore in Rome, 00168 Rome, Italy. gianfranco.damiani@unicatt.it.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Damiani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003710:Demography; D019468:Disease Management; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015995:Prevalence; D011320:Primary Health Care; D011787:Quality of Health Care; D012923:Social Class; D055815:Young Adult
keywords: health care research; inequalities; primary health care; quality of care