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Practice-level variation in use of recommended medications among outpatients with heart failure: Insights from the

Pamela N Peterson1, Paul S Chan, John A Spertus

  • 1Department of Medicine, Denver Health Medical Center, Denver, CO.

Circulation. Heart Failure
|October 17, 2013
PubMed

Insights

Significant variation exists in guideline-recommended heart failure medication use among cardiology practices. Addressing these practice-level differences is key to improving care for heart failure with reduced ejection fraction patients.

Area of Science:

  • Cardiology
  • Health Services Research
  • Pharmacotherapy

Background:

  • Guideline-recommended treatments for heart failure with reduced ejection fraction (HFrEF) are crucial for patient outcomes.
  • Previous studies have highlighted patient-level factors influencing treatment, but practice-level variations remain less understood.

Purpose of the Study:

  • To assess practice-level variability in prescribing guideline-recommended therapies for HFrEF outpatients.
  • To investigate the association between treatment variations and practice sites, controlling for patient characteristics.

Main Methods:

  • Analysis of data from 12,556 HFrEF patients across 45 cardiology practices (July 2008-December 2010).
  • Evaluation of prescription rates for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and beta-blockers.
  • Utilization of multivariable hierarchical regression models and median rate ratios to quantify practice variation, adjusted for patient demographics, insurance, and comorbidities.

Main Results:

  • Substantial practice-level variation observed in medication use: median rates were 85% for ACE inhibitors/ARBs, 92% for beta-blockers, and 79% for optimal combined therapy.
  • Adjusted median rate ratios indicated significant practice-level differences, with ratios of 1.11 for ACE inhibitors/ARBs, 1.08 for beta-blockers, and 1.17 for optimal combined treatment.

Conclusions:

  • Practice-level variation in guideline-directed medical therapy for HFrEF is a significant issue in outpatient cardiology.
  • Targeting and addressing these practice-level disparities are essential for enhancing the quality of care for HFrEF patients.
Abstract

Keywords:
heart failurepharmaceutical preparationsregistries

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