Heart failure pharmacotherapy guideline implementation and survival in patients from community hospital: a retrospective study
Keywords:
Key-words, heart failure, guidelines, mortality, pharmacotherapyAbstract
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.
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.
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).
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.
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