Abstract
Background: Internationally research indicates that pharmacotherapy for chronic heart failure (CHF) is sub-optimal. However, assessment of drug use in heart failure has traditionally focused on the use of individual agents without taking CHF severity into account. This study investigates investigate the pharmacological treatment of CHF in general practice with respect to the available evidence, incorporating both disease severity and the use of combination drug therapy.
Design: Cross-sectional survey
Setting: Dutch General Practice
Participants: 769 CHF patients participating in the IMPROVEMENT of HF
study.
Outcomes: For each NYHA severity classification the minimum treatment each patient could expect, appropriate for their NYHA severity classification according to the scientific evidence available at the time of the study (1999) was defined. The proportion of patients receiving, at least, the minimum evidence-based regime per NYHA severity class was determined.
Results: The proportion of patients treated with each drug group increased with increasing CHF severity classification, with the exception of the beta-blockers. With respect to the current evidence, the proportion of patients receiving the minimum evidence-based regime suitable for their severity class decreased as NYHA severity class increased. After adjusting for age and sex, patients with less severe heart failure (NYHA classes 1 and 2) were four to eight times more likely to receive evidence-based treatment than those with more severe heart failure (NYHA class 3 and 4).
Discussion: This study indicates that many heart failure patients in general practice are not receiving evidence-based care when disease severity and combination drug therapy are taken into account. While prescribing of ACE inhibitors appeared adequate, prescribing of beta-blockers was low and indicates an area needing attention. Educational efforts aimed at the improvement of heart failure treatment in general practice are needed, with special consideration given to the role of beta-blockers in the treatment of heart failure.
Design: Cross-sectional survey
Setting: Dutch General Practice
Participants: 769 CHF patients participating in the IMPROVEMENT of HF
study.
Outcomes: For each NYHA severity classification the minimum treatment each patient could expect, appropriate for their NYHA severity classification according to the scientific evidence available at the time of the study (1999) was defined. The proportion of patients receiving, at least, the minimum evidence-based regime per NYHA severity class was determined.
Results: The proportion of patients treated with each drug group increased with increasing CHF severity classification, with the exception of the beta-blockers. With respect to the current evidence, the proportion of patients receiving the minimum evidence-based regime suitable for their severity class decreased as NYHA severity class increased. After adjusting for age and sex, patients with less severe heart failure (NYHA classes 1 and 2) were four to eight times more likely to receive evidence-based treatment than those with more severe heart failure (NYHA class 3 and 4).
Discussion: This study indicates that many heart failure patients in general practice are not receiving evidence-based care when disease severity and combination drug therapy are taken into account. While prescribing of ACE inhibitors appeared adequate, prescribing of beta-blockers was low and indicates an area needing attention. Educational efforts aimed at the improvement of heart failure treatment in general practice are needed, with special consideration given to the role of beta-blockers in the treatment of heart failure.
| Original language | English |
|---|---|
| Article number | P2126 |
| Pages (from-to) | 402-402 |
| Number of pages | 1 |
| Journal | European Heart Journal |
| Volume | 23 |
| Issue number | abstract supplement |
| Publication status | Published - Aug 2002 |
| Externally published | Yes |
| Event | Congress of the European Society of Cardiology (ESC) - Berlin, Germany Duration: 31 Aug 2002 → 4 Sept 2002 |