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Effect of heart failure program on cardiovascular drug utilization and dosage in patients with chronic heart failure
T M Ramahi1, M D Longo, K Rohlfs
1Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut 06510-2483, USA.
Insights
Specialized heart failure programs improve cardiovascular drug use in chronic heart failure (CHF) patients. This care enhances medication adherence and dosage, leading to better patient outcomes and survival rates.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Low utilization and dosage of ACE inhibitors in chronic heart failure (CHF) patients.
- Specialized heart failure programs may improve clinical outcomes for CHF patients.
Purpose of the Study:
- To assess the impact of specialized heart failure care on cardiovascular drug utilization and dosage.
- To evaluate clinical outcomes, including hospitalization and survival, in CHF patients within a heart failure program.
Main Methods:
- Analysis of data from 133 CHF patients in a specialized heart failure program.
- Examination of cardiovascular drug utilization and dosage at baseline and follow-up (average 17 months).
- Determination of hospitalization and survival rates.
Main Results:
- Significant increase in ACE inhibitor and ARB utilization (87% to 100%) and dosage (60% increase).
- Increased utilization of beta-blockers, metolazone, spironolactone, amiodarone, hydralazine, and nitrates.
- One-year survival rate of 90%; low 3- and 6-month hospitalization rates for heart failure and cardiovascular causes.
Conclusions:
- Specialized heart failure programs significantly increase utilization and dosage of beneficial cardiovascular drugs, particularly ACE inhibitors.
- Care in heart failure programs is associated with excellent clinical outcomes, including improved survival and reduced hospitalizations.
Background:
Utilization and dosage of angiotensin-converting enzyme (ACE) inhibitors in patients with chronic heart failure (CHF) remain low. Recent data suggest that care of patients with CHF in specialized heart failure programs is associated with improved clinical outcomes.
Hypothesis:
Specialized heart failure care is associated with better utilization and higher dose of cardiovascular drugs.
Methods:
Data from 133 patients with CHF referred to a heart failure program were analyzed. Mean functional class 3.1 +/- 0.5, left ventricular ejection fraction 19 +/- 8. Utilization and doses of cardiovascular drugs were examined at initial evaluation and at last visit, after an average period of 17 +/- 14 months. Hospitalization and survival data were determined.
Results:
Utilization of ACE inhibitors and angiotensin-receptor blockers increased from 87 to 100% (p < 0.001). Average daily dose increased by 60%, from the equivalent of captopril 105 +/- 78 mg to 167 +/- 86 mg (p < 0.001). Utilization of the following drugs increased significantly: beta blockers (16-37%, p < 0.001), metolazone (10-23%, p = 0.007), spironolactone (1-36%, p < 0.001), amiodarone (7-15%, p = 0.05), hydralazine (1-9%, p = 0.004), and nitrates (20-33%, p = 0.03). One-year survival was 90%. The 3- and 6-month hospitalization rates for heart failure were 4 and 7%, and for all cardiovascular causes they were 6 and 11%, respectively.
Conclusions:
Care of patients with CHF in a specialized heart failure program was associated with significant increase in the utilization and doses of all beneficial cardiovascular drugs, especially ACE inhibitors. It was also associated with excellent clinical outcomes.