Heart failure pharmacotherapy guideline implementation and survival in patients from community hospital: a retrospective study
<p>Background. Few studies have investigated implementation of heart failure (HF) pharmacotherapy in non-selected community setting. We aimed to investigate pharmacotherapy at discharge from hospital and potential associations with all-cause mortality.</p><p>Methods. In this retros...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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Slovenian Medical Association
2014-08-01
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| Series: | Zdravniški Vestnik |
| Subjects: | |
| Online Access: | http://vestnik.szd.si/index.php/ZdravVest/article/view/74 |
| Summary: | <p>Background. Few studies have investigated implementation of heart failure (HF) pharmacotherapy in non-selected community setting. We aimed to investigate pharmacotherapy at discharge from hospital and potential associations with all-cause mortality.</p><p>Methods. In this retrospective study, hospital discharges and deaths from a community hospital in period 2001-2003 were screened for diagnosis of HF. Patient and pharmacotherapy information was retrieved from medical records and survival information was obtained from Central population registry.</p><p>Results. We included 638 patients (73±10 years, 48% men, 74% NYHA class III on admission). Echocardiography report was available for 61% and 70% of those imaged (43% of total population) had left ventricular systolic dysfunction. A median of 6 (interquartile range 1-14) drugs, 4 (interquartile range 0-10) being for cardiovascular disease, was prescribed at discharge. Over years, prescription rate of beta-blockers (BB) increased whereas it remained stable for angiotensin converting enzyme (ACE) inhibitors. Target dose of BB and ACE inhibitors was prescribed to 4% and 20%, respectively. Combined neurohormonal antagonist therapy was prescribed to 83 (13%) of patients, which was associated with lower all-cause mortality risk in a multivariate model (hazard ratio 0.69, 95% confidence interval 0.49-0.98). Higher dose of ACE inhibitors was also associated with better outcome (hazard ratio per tertile: 0.79, 95% confidence interval 0.68-0.93).</p><p>Conclusions. In our non-selected community based HF cohort, pharmacotherapy was not implemented as appropriate. When applied, pharmacological therapy with neurohormonal antagonists was associated with better outcome.</p> |
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| ISSN: | 1318-0347 1581-0224 |