Trends in prescribing for heart failure in Dutch primary care from 1996 to 2000

Abstract

SUMMARYPurpose The aim of this study is to explore trends in primary care prescribing for chronic heart failure (CHF) over a 5-year period (1996)(1997)(1998)(1999)(2000). Methods This study consisted of repeated cross-sectional surveys in a dynamic cohort from the Integrated Primary Care Information (IPCI) primary care database. The cohort comprised all patients aged ! 55 years with a CHF diagnosis and prescribed a cardiovascular medication during the study period. The point prevalence per calendar year was determined for each of the main drug groups used to treat CHF. Results The study population consisted of 3121 CHF patients. Small increases were seen in the percentage of CHF patients prescribed spironolactone (4.6%, 95% CI: 2.3-6.9%), -blockers (6.1%, 95% CI: 2.6-9.5%) and angiotensin II antagonists (6.8%, 95% CI: 5.1-8.6%) during the study period, while the prescribing of digoxin decreased (À4.4%, 95% CI: À8.2 to À0.7). Prescribing of diuretics (difference: À0.7% 95% CI: À2.7-4.2) and ACE inhibitors (difference: 4.0% 95% CI: À0.1-8.2%) remained unchanged. Conclusions Prescription of some drug groups for CHF increased. However, given the new scientific evidence that has emerged in past 15 years regarding CHF pharmacotherapy, the changes observed were less than expected.

Physician, organisational and patient characteristics explaining the use of angiotensin converting enzyme inhibitors in heart failure treatment: a multilevel study

“…Also, in patients whose diagnosis is based on signs and symptoms, as is usually the case in Dutch general practice, ACE inhibitors are considered standard long-term therapy after starting treatment with diuretics [2]. Although treatment pattern differs between countries [3], ACE inhibitors are generally underused and under-dosed in general practice [4][5][6].…”

Trends and inequities in beta-blocker prescribing for heart failure

“…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.…”

“…[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.…”

Beyond dyssynchrony in cardiac resynchronisation therapy

“…Differences in ischaemic and non-ischaemic aetiologies may be responsible,37 but variations in primary management of chronic heart failure may also have a significant role 38 – 41. The EuroHeart Failure Survey42 reported that <50% of patients receiving drug treatment for chronic heart failure were receiving β blockers, though 80% were taking an ACE inhibitor.…”

“…Similarly, baseline characteristics from the CARE-HF33 study reported that although 95% of patients were receiving ACE inhibitors or angiotensin receptor blockade treatment, only 38% had achieved at least half target dose; and although 72% of patients were receiving β-blocker treatment, only 39% had achieved at least half target dose. These disparities suggest that a significant proportion of patients with chronic heart failure are not receiving optimum medical treatment33 38 – 41 before referral for further pacemaker or surgical intervention. Indeed, patients in tertiary centres may be benefiting from continued pharmacological optimisation after CRT.…”