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Utilization of evidence-based treatment in elderly patients with chronic heart failure: using Korean Health Insurance

Ju-Young Kim1, Hwa-Jung Kim, Sun-Young Jung

  • 1Department of Family Medicine, Seoul National University Bundang Hospital, Seoul, Korea.

BMC Cardiovascular Disorders
|August 2, 2012
PubMed

Insights

Evidence-based treatments for chronic heart failure are underutilized in elderly patients. Factors like hospital type and provider specialty significantly influence treatment access and adherence for heart failure management.

Area of Science:

  • Gerontology
  • Cardiology
  • Health Services Research

Background:

  • Chronic heart failure (CHF) significantly impacts morbidity and mortality in aging populations.
  • Established evidence-based treatments (EBTs) for CHF include ARBs, ACE-I, beta-blockers, and aldosterone antagonists.
  • Underutilization of these EBTs in CHF patients is frequently reported, potentially increasing adverse outcomes.

Purpose of the Study:

  • To evaluate the utilization rates of EBTs for elderly patients diagnosed with chronic heart failure.
  • To identify factors associated with the underutilization of evidence-based pharmacologic treatments in this demographic.

Main Methods:

  • Retrospective observational study utilizing the Korean National Health Insurance claims database.
  • Identification of EBT prescriptions for elderly patients hospitalized for CHF between January 1, 2005, and June 30, 2006.

Main Results:

  • Beta-blockers were prescribed to 31.5% and ACE-I or ARBs to 54.7% of 28,922 elderly CHF patients.
  • Factors associated with underutilization included outpatient clinic prescription, less specialized healthcare providers, rural residence, and non-tertiary hospital admission.
  • Patients not receiving EBTs were more likely to have dementia and less likely to have comorbid cardiovascular diseases or concomitant medications.

Conclusions:

  • Healthcare system factors (hospital type), provider factors (specialty), and patient factors (comorbidities, concomitant medications) collectively influence EBT underutilization in heart failure.
  • Addressing these multifactorial barriers is crucial for improving evidence-based pharmacologic treatment adherence in elderly heart failure patients.
  • Optimizing CHF management requires a comprehensive approach considering systemic, provider, and patient-level influences.
Abstract

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