© 2004 European Society of Cardiology
Relation of sex, age and concomitant diseases to drug prescription for heart failure in primary care in Europe*
a Department of Internal Medicine, University Hospital Zurich, Switzerland
b L'Hôpital Beaujon Clichy, France
c Department of Primary Care and General Practice, University of Birmingham Birmingham, UK
d Department of Cardiology, University of Hull Kingston upon Hull, UK
* Corresponding author. Present address: Cardiovascular center, University Hospital, 8091 Zurich, Switzerland. Tel.: +41-1-255-85-83; Fax: +41-1-255-45-54. E-mail address: joerg.muntwyler{at}dim.usz.ch
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Abstract |
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Aim: To study the role of sex, age and concomitant diseases for prescription of cardiovascular drugs among patients with heart failure cared for in the community.
Methods and Results: In 15 European countries, a survey was conducted during 1999 and 2000 among 1363 primary care physicians who included 8256 patients with symptoms of heart failure. Predictors of drug prescription were assessed with multivariate logistic regression. Overall prescription rates for ACE-inhibitors/angiotensin receptor blockers (ACE-I/ARB), beta-blockers, digitalis, diuretics and oral anticoagulants were 69%, 30%, 41%, 75% and 18%. Women had no reduced likelihood to receive ACE-I/ARB and beta-blockers (odds ratio [OR]=0.96 [95% CI 0.87–1.06] and 1.02 [0.92–1.13], respectively), but prescription of oral anticoagulants was decreased (OR=0.74, 95% CI 0.65–0.84). Compared to patients <65 years of age, ACE-I/ARB prescription did not materially decline up to 75–85 years (R=0.91, 95% CI 0.81–1.04), whereas beta-blocker prescription was already significantly decreased in this age category (OR=0.49, 95% CI 0.43–0.56). There was no general under-prescription of evidence-based cardiovascular drugs in patients with concomitant diseases.
Conclusions: Among heart failure patients cared for in the community advanced age strongly predicts decreased prescription of beta-blockers. Female sex and comorbidity is not associated with a consistent underutilization of evidence-based cardiovascular drugs.
Key Words: Heart failure • Drug utilization • Quality of care • ACE-inhibitors • Beta-blockers • Oral anticoagulants
Received July 14, 2003; Revised February 19, 2004; Accepted March 10, 2004
Funding: Unrestricted educational grant by SERVIER SA, Paris, France and the respective country braches.
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