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: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Slovenian Medical Association
2014-08-01
|
| Series: | Zdravniški Vestnik |
| Subjects: | |
| Online Access: | http://vestnik.szd.si/index.php/ZdravVest/article/view/74 |
| _version_ | 1818150856159133696 |
|---|---|
| author | Lea Majc Hodošček Mitja Lainscak |
| author_facet | Lea Majc Hodošček Mitja Lainscak |
| author_sort | Lea Majc Hodošček |
| collection | DOAJ |
| description | <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> |
| first_indexed | 2024-12-11T13:29:34Z |
| format | Article |
| id | doaj.art-3a99aea8e8c845269e77064f9f2a11de |
| institution | Directory Open Access Journal |
| issn | 1318-0347 1581-0224 |
| language | English |
| last_indexed | 2024-12-11T13:29:34Z |
| publishDate | 2014-08-01 |
| publisher | Slovenian Medical Association |
| record_format | Article |
| series | Zdravniški Vestnik |
| spelling | doaj.art-3a99aea8e8c845269e77064f9f2a11de2022-12-22T01:05:20ZengSlovenian Medical AssociationZdravniški Vestnik1318-03471581-02242014-08-01830943Heart failure pharmacotherapy guideline implementation and survival in patients from community hospital: a retrospective studyLea Majc Hodošček0Mitja Lainscak1General hospital Murska Sobota, Doctor of internal medicineDivision of Cardiology Golnik University Clinic of Respiratory and Allergic Diseases<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>http://vestnik.szd.si/index.php/ZdravVest/article/view/74Key-words: heart failureguidelinesmortalitypharmacotherapy |
| spellingShingle | Lea Majc Hodošček Mitja Lainscak Heart failure pharmacotherapy guideline implementation and survival in patients from community hospital: a retrospective study Zdravniški Vestnik Key-words: heart failure guidelines mortality pharmacotherapy |
| title | Heart failure pharmacotherapy guideline implementation and survival in patients from community hospital: a retrospective study |
| title_full | Heart failure pharmacotherapy guideline implementation and survival in patients from community hospital: a retrospective study |
| title_fullStr | Heart failure pharmacotherapy guideline implementation and survival in patients from community hospital: a retrospective study |
| title_full_unstemmed | Heart failure pharmacotherapy guideline implementation and survival in patients from community hospital: a retrospective study |
| title_short | Heart failure pharmacotherapy guideline implementation and survival in patients from community hospital: a retrospective study |
| title_sort | heart failure pharmacotherapy guideline implementation and survival in patients from community hospital a retrospective study |
| topic | Key-words: heart failure guidelines mortality pharmacotherapy |
| url | http://vestnik.szd.si/index.php/ZdravVest/article/view/74 |
| work_keys_str_mv | AT leamajchodoscek heartfailurepharmacotherapyguidelineimplementationandsurvivalinpatientsfromcommunityhospitalaretrospectivestudy AT mitjalainscak heartfailurepharmacotherapyguidelineimplementationandsurvivalinpatientsfromcommunityhospitalaretrospectivestudy |