Improved evidence-based medication use in patients hospitalised for heart failure

January 01, 0001

Improved evidence-based medication use in patients hospitalised for heart failure

The aim of this retrospective multicentre cohort study, with medical record review by researchers from Perth, Western Australia (WA) was to examine trends and predictors of prescription on discharge after first (index) hospitalisation for heart failure (HF), and the effect on all-cause mortality of evidence-based therapy. The study was set in three tertiary-care hospitals. WA Hospital Morbidity Data were used to identify a random sample of 1006 patients with an index admission to hospital for HF between 1996 and 2006.

Among 944 patients surviving to hospital discharge, the prescription rate of angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) (74.3%) and loop diuretics (85.5%) remained high over the study period, whereas that of beta-blockers and spironolactone increased (10.5% to 51.3% and 1.4% to 23.3%, respectively), and digoxin prescription decreased (38.1% to 20.7%). The temporal trends in use of beta-blockers, spironolactone and digoxin were in line with clinical trial evidence. Age = 75 years was a significant, negative predictor of beta-blocker and spironolactone prescription. In-hospital echocardiography, performed in 53% of patients, was associated with a significantly greater likelihood of treatment with ACE inhibitors/ARBs, beta- blockers and spironolactone. Both ACE inhibitors/ARBs and beta-blockers prescribed on discharge were associated with a lower adjusted hazard ratio (HR) for mortality at 1-year (HR, 0.71; significant and HR, 0.68; significant respectively).

The researchers concluded: "ACE inhibitors/ARBs and beta-blockers, prescribed during initial hospitalisation for HF, are associated with improved long- term survival. Therapy became more evidence based over the study period, but echocardiography, an important predictor of evidence-based therapy, was underutilised."

Evidence, perhaps, for improved therapy, but not improved outcome, despite the title of the study (although evidence from elsewhere suggests so).

For the full abstract, click here.

MJA 192(6):306-310, 15 March 2010 © The Medical Journal of Australia 2010
The effect of evidence-based medication use on long-term survival in patients hospitalised for heart failure in Western Australia. Tiew-Hwa Katherine Teng, Joseph Hung and Judith Finn. Correspondence to Tiew-Hwa Katherine Teng: [email protected]

Category: K. Circulatory. Keywords: evidence based, medication use, hert failure, retrospective multicentre cohort study, with medical record review, journal watch.
Synopsis edited by Dr Stephen Wilkinson, Melbourne, Australia. Posted on Global Family Doctor 2 April 2010

Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.

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