Treatment with angiotensin converting enzyme inhibitors, angiotensin-II-antagonists and beta-blockers in an unselected group of patients with chronic heart failure

Watz, Ragnar; Ekstrand, A. Jonas; Engelbrektson, Victoria; Beermann, B

doi:10.1007/s00228-005-0892-y

Cited by 5 publications

(10 citation statements)

References 19 publications

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“…All patients with heart failure will not be suitable for beta-blocker therapy but other studies found that 70-80% of unselected patients with heart failure are suitable for, and tolerate, beta-blocker therapy. 16,27,28 Compared with this, the present study's treatment rate with recommended beta-blockers of 24.7% is low and suggests the potential for further improvements in prescribing. If there is potential for a further 45% of patients to be treated with recommended beta-blockers, extrapolating the present findings to the whole of the UK, this would suggest up to 155 000 additional patients aged over 50 years could be treated.…”

Section: Implications For Clinical Practice and Future Researchcontrasting

confidence: 56%

“…The majority have studied hospital discharge or outpatient populations or were conducted outside the UK. [11][12][13][14][15][16] These studies have generally reported higher utilisation of beta-blockers. The EuroHeart Failure study, a survey of hospital discharges across 24 European countries, reported 36.9% utilisation in 2000-2001, with a lower proportion in the UK.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…[7][8][9][10] A number of studies in other countries suggest that beta-blocker therapy is underused, with age and sex inequities. [11][12][13][14][15][16] Little is known about recent trends and current inequities in the UK; the available evidence suggests low use compared with other European countries, but this predates the inclusion of beta-blocker therapy in national guidelines. 17,18 In this article a large representative primary care database is used to describe trends and inequities in beta-blocker use since 2000.…”

Section: Introductionmentioning

confidence: 99%

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Trends and inequities in beta-blocker prescribing for heart failure

Shah

Carey²,

DeWilde³

et al. 2008

Br J Gen Pract

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Treatment with specific beta-blockers reduces mortality and hospitalisation in heart failure. AimTo describe trends and inequities in beta-blocker prescribing for heart failure. Design of studyRepeated cross-sectional analysis of a nationally representative primary care database (DIN-LINK). SettingA total of 152 UK general practices. MethodPrescribing of beta-blockers between 2000 and 2005 was examined among a yearly average of 7294 patients aged ≥50 years who had actively managed heart failure -defined as a recorded diagnosis of heart failure and two prescriptions of an angiotensinconverting enzyme inhibitor or angiotensin receptor blocker during the calendar year. The main outcome was the prescription of a guideline-recommended beta-blocker (bisoprolol, carvedilol, metoprolol, or nebivolol) in the year. Determinants of beta-blocker prescribing were analysed using logistic regression. ResultsBetween 2000 and 2005, age-adjusted use of recommended beta-blockers rose from 6.1% to 27.0% in men, and from 4.2% to 21.5% in women. In 2005, younger patients were more likely to be treated; the fully adjusted odds ratio was 4.83 (95% confidence interval = 3.78 to 6.17) for patients aged 60-64 years compared with those aged 85 years. Women and patients living in areas of socioeconomic deprivation were less likely to be treated. In 2005, in addition to treatment with guideline-recommended beta-blockers, a further 11.7% of men and 12.5% of women were prescribed other beta-blockers. ConclusionRecommended beta-blocker use has risen in the UK but remains low and inequitable, with many patients still treated with beta-blockers that are not recommended in guidelines. This suggests further improvements in prescribing are still possible.

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Section: Implications For Clinical Practice and Future Researchcontrasting

confidence: 56%

Section: Comparison With Existing Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Trends and inequities in beta-blocker prescribing for heart failure

Shah

Carey²,

DeWilde³

et al. 2008

Br J Gen Pract

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“…Studies in primary care show that a higher accessibility to a GP reduces the number of hospitalizations (96). Studies have shown that there is limited use in the PHC of medication recommended for HF, and when it is used, it is in in sub-optimal dosages (7,97).…”

Section: Heart Failure In Primary Healthcarementioning

confidence: 99%

“…When HF is based on clinical criteria, basically 50% of the patients will have an incorrect diagnosis (4,19,25,64). In comparison with other studies which are population-or PHC-based, echocardiography was applied in 8-30% of patients with the diagnosis of HF in the PHC (6,7,97). Consequently, there is a substantial risk that the diagnosis is incorrect and that patient will receive inappropriate treatment.…”

Section: Diagnostic Considerations Of Heart Failure In Primary Healthmentioning

confidence: 99%

Heart failure in primary care with special emphasis on costs and benefits of a disease management programme

Agvall¹

2014

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Adequacy of diagnosis and treatment of chronic heart failure in primary health care in Sweden

Dahlström

Håkansson²,

Swedberg

et al. 2009

European J of Heart Fail

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AimsWe performed an observational multicentre study to obtain information of the diagnostic tools and treatments currently used in patients with chronic heart failure (CHF) in primary health care (PHC) in Sweden. Data were collected from 2093 patients in 158 randomly selected PHC centres. Methods and resultsThe mean age was 79 years. The dominating aetiology of HF was hypertension and/or ischaemic heart disease. Diagnosis was based on symptoms and/or ECG and/or chest X-ray in 69% of the patients. Treatment with a reninangiotensin system (RAS) blocker was ongoing in 74% of the patients, but only 37% had 50% of the recommended target dose. In 68%, treatment with a beta-blocker (BB) was present, but only 31% had 50% of the recommended target dose. Only 42% of the patients were on treatment with an RAS blocker and a BB and only 20% had 50% of the recommended target dose. ConclusionThe diagnostic criteria for CHF according to the European Society of Cardiology were fulfilled in only 30% of the patients. In addition, evidenced-based treatments to reduce morbidity and mortality were markedly underused, particularly regarding dosing. Our findings may reflect the patients' high age and the presence of important

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Treatment with angiotensin converting enzyme inhibitors, angiotensin-II-antagonists and beta-blockers in an unselected group of patients with chronic heart failure

Abstract: CHF was not optimally diagnosed in this cohort of patients. Correct diagnosing seems to be associated with more adequate treatment.

Cited by 5 publications

References 19 publications

Trends and inequities in beta-blocker prescribing for heart failure

Trends and inequities in beta-blocker prescribing for heart failure

Heart failure in primary care with special emphasis on costs and benefits of a disease management programme

Adequacy of diagnosis and treatment of chronic heart failure in primary health care in Sweden

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