Temporal Patterns in the Medical Treatment of Congestive Heart Failure With Angiotensin-Converting Enzyme Inhibitors in Older Adults, 1989 Through 1995

Smith, Nicholas L.; Psaty, Bruce M.; Pitt, Bertram; Garg, Rekha; Gottdiener, John S.; Heckbert, Susan R.

doi:10.1001/archinte.158.10.1074

Cited by 71 publications

(38 citation statements)

References 29 publications

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“…These data are consistent with the IMPROVEMENT study [33] and EuroHeart Failure Surveys and suggest that much of the national Portuguese data are relevant to patients in many other ESC countries [38][39][40]. The difference between selected CHF patient populations with LVSD included in large randomised trials and drealworldT CHF patients is a classical problem of today's evidence-based medicine [26][27][28][29]32]. This difference, compounded by other factors such as lack of training, lack of resources, fear of adverse effects and polypharmacy and, of course, the higher prevalence of CHF with preserved systolic function [6,12,41], probably accounts for the failure to prescribe effective therapy to many patients.…”

Section: Discussionsupporting

confidence: 71%

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Aetiology, comorbidity and drug therapy of chronic heart failure in the real world: the EPICA substudy

Ceia

Fonseca

Mota

et al. 2004

European J of Heart Fail

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Background: Chronic heart failure (CHF) is common and is frequently managed by primary care physicians (PCPs). Despite the European Society of Cardiology (ESC) Guidelines, standard treatments for CHF are frequently underutilised, particularly in primary care. Aim: To evaluate current drug therapy for CHF in adults with HF diagnosed according to ESC guidelines in the context of the EPICA study. Aetiological features and therapy relevant comorbidities were also analysed. Methods: EPICA was a community-based epidemiological study conducted in mainland Portugal. The study involved 365 primary care physicians, who evaluated 6300 primary care attendees aged over 25 years. CHF was diagnosed by clinical and echocardiography criteria according to ESC guidelines. Results: Total of 551 cases of CHF were identified, with a mean age of 65F9 years. The estimated overall prevalence of CHF in the Portuguese population was 4.4%; 1.3% with and 1.7% without left ventricular systolic dysfunction (LVSD). There are 6,280,792 people aged N25 years in Portugal, which extrapolates to 261,400 cases of heart failure. About 80% of patients had a history of hypertension, 39% had a history of coronary artery disease and 15% had atrial fibrillation. Only 58% of patients were on angiotensin-converting enzyme (ACE) inhibitors and 7% on beta-blockers. The type of ventricular dysfunction, age and presence of renal failure had little effect on prescription rates. Diuretics were prescribed in 78%. Thiazides were used more frequently in those with preserved systolic function and frusemide in those with left ventricular systolic dysfunction. Digoxin was prescribed more often to patients with than without left ventricular systolic dysfunction (34% vs. 17%; p=0.02). Long-acting nitrates were prescribed to 20% and amiodarone to 8% of patients. Conclusion: The EPICA study, as in other studies in primary care in Europe, particularly the IMPROVEMENT study, suggests that greater efforts are required to improve training of primary care teams in the management of CHF.

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Section: Discussionsupporting

confidence: 71%

“…Treatment of CHF with preserved left ventricular function is still empirical, based on aetiology and pathophysiological changes [12,13,25]. Despite evidence and guidelines, probably only a minority of patients with CHF are being correctly treated with ACE inhibitors and beta-blockers [26][27][28][29][30][31][32][33].…”

Section: Introductionmentioning

confidence: 99%

Aetiology, comorbidity and drug therapy of chronic heart failure in the real world: the EPICA substudy

Ceia

Fonseca

Mota

et al. 2004

European J of Heart Fail

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“…11,25,26 Similarly, the use of pharmacotherapies that have been demonstrated to reduce mortality in various heart disease populations, such as aspirin, lipid-lowering medications, ␤-blockers, angiotensin-converting enzyme in- hibitors, thrombolytics, and amiodarone, has also increased over time. [27][28][29][30][31] Temporal trends in some health behaviors such as smoking have improved over time, while trends in others such as exercise or diet are less certain. [32][33][34] Finally, among persons aged 65 years or greater who are admitted to the hospital with a diagnosis of ventricular arrhythmia in the United States, the use of implantable cardioverter defibrillators has increased substantially from the mid 1980s through the mid 1990s.…”

Section: Discussionmentioning

confidence: 99%

Temporal Patterns in Long-Term Survival After Resuscitation From Out-of-Hospital Cardiac Arrest

et al. 2003

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Background— During the past quarter century, advances in treatment of cardiovascular disease have occurred that might potentially benefit survivors of sudden cardiac arrest (SCA). Little is known, however, about the temporal patterns in long-term survival among persons resuscitated from SCA. We hypothesized that long-term survival would improve over time and that this temporal pattern would be most evident for cardiac causes of death. Methods and Results— The investigation was a retrospective cohort study of survival among persons who were discharged alive from the hospital after resuscitation from out-of-hospital SCA due to heart disease in King County, Wash, between May 1, 1976, and December 31, 2001 (n=2035). Calendar time was divided into four 5-year intervals: 1976 to 1980, 1981 to 1985, 1986 to 1990, and 1991 to 1995, and one 6-year interval, 1996 to 2001. Age-adjusted survival curves were constructed, and Cox proportional-hazards regression was used to compute hazard ratios (HRs) for the association between mortality and time period. During 11 201 person-years of follow-up, 1334 persons died. Compared with the initial time period, the HR for total mortality was 0.86 (95% confidence interval, 0.73 to 1.01) for 1981 to 1985, 0.82 (0.69 to 0.96) for 1986 to 1990, 0.66 (0.55 to 0.79) for 1991 to 1995, and 0.58 (0.47 to 0.71) for 1996 to 2001 (HR for trend=0.87 [0.84 to 0.91] for each successive time period). In analyses that assessed cardiac mortality, an even stronger temporal association was evident (HR for trend=0.79 [0.75 to 0.84]). Conclusions— Long-term survival after resuscitation from SCA improved steadily over time in this cohort. To continue this trend, future studies should identify circumstances in which proven treatments are underutilized as well as investigate new therapies that might benefit survivors of SCA.

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“…While practice guidelines have synthesized best evidence and clinical judgment into specific recommendations for clinicians, many patients receive suboptimal care. Important physician factors that may contribute to CHF exacerbations are under-utilization of established therapy such as ACE inhibitors that can reduce morbidity and mortality, and suboptimal education, including low rates of general and dietary counseling (Smith et al, 1998;CONSENSUS, 1987;SOLVD, 1991;IPRO, 1996). Medication and dietary nonadherence (with sodium restriction), inadequate discharge planning and follow-up, lack of social support and not seeking medical attention promptly when symptoms recur also increase the risk of CHF exacerbations (Ni et al, 1999;Ghali, Kadakia, Cooper, & Ferlinz, 1988;Chin & Goldman, 1997;Vinson, Rich, Sperry, Atul, & McNamara, 1990, Tsuyuki et al, 2001Michalsen, Konig, & Thimme, 1998).…”

Section: Introductionmentioning

confidence: 99%

A story of maladies, misconceptions and mishaps: effective management of heart failure

Horowitz¹,

Rein²,

Leventhal³

2004

Social Science & Medicine

242

283

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Congestive heart failure (CHF) is a common chronic disease with effective therapy, yet interventions to improve outcomes have met with limited success. Though problems in selfmanagement are suspected causes for deterioration, few efforts have been made to understand how self-management could be improved to enhance the lives of affected patients. We conducted semistructured interviews of 19 patients with CHF treated at an urban United States hospital to elucidate their knowledge and beliefs about CHF and to understand what underlies their self-care routines. A comparison of the themes generated from these interviews with the common-sense model for self-management of illness threats, clarifies how patients' perceptions and understanding of CHF affected their behaviors. Patients had an acute model of CHF. They did not connect chronic symptoms with a chronic disease, CHF, and did not recognize that these symptoms worsened over time from their baseline of moderate, chronic distress, to a severe state that required urgent care. As a consequence, they often did not manage symptoms on a routine basis and did not, therefore, prevent or minimize exacerbations. When they worsened, many patients reported barriers to reaching their physicians and most reported seeking care primarily in an emergency room.These in depth responses elucidate how the interplay between acute and chronic models of a chronic illness effect self-management behaviors. These factors play a previously not understood role in patient's efforts to understand and manage the ever-present but symptomatically variable chronic illness that is CHF. These new concepts illustrate the tools that may be needed to effectively manage this serious and disabling illness, and suggest possible ways to enhance the self-management process and ultimately improve patients' lives.

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Temporal Patterns in the Medical Treatment of Congestive Heart Failure With Angiotensin-Converting Enzyme Inhibitors in Older Adults, 1989 Through 1995

Abstract: These findings suggest that, while the medical management of CHF with ACE inhibitors has increased modestly over time in prevalent cases, these drugs may still be underused, especially among incident cases.

Cited by 71 publications

References 29 publications

Aetiology, comorbidity and drug therapy of chronic heart failure in the real world: the EPICA substudy

Aetiology, comorbidity and drug therapy of chronic heart failure in the real world: the EPICA substudy

Temporal Patterns in Long-Term Survival After Resuscitation From Out-of-Hospital Cardiac Arrest

A story of maladies, misconceptions and mishaps: effective management of heart failure

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