© 2005 European Society of Cardiology
Influence of age and in-patient care on prescription rate and long-term outcome in chronic heart failure: a data-based substudy of the EuroHeart Failure Survey
Department of Cardiology, University of Vienna Währinger Gürtel 18-20, A-1090 VIENNA, Austria
* Corresponding author. Tel.: +43 1 404004616; Fax: +43 1 4081148. E-mail address: martin.huelsmann{at}meduniwien.ac.at
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Abstract |
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Aims: To evaluate the prescription rate of neurohumoral drugs in chronic heart failure patients and the factors influencing prescription rates. Outcomes and their predisposing factors were also investigated.
Methods and results: Of 1482 consecutive patients admitted to 3 Austrian hospitals participating in the EuroHeart Failure Survey, 341 were included in this data-based substudy. Follow-up time to evaluate outcome was up to 46 months. The prescription rates of renin–angiotensin (RAAS) antagonists and β-blockers at the time of discharge were evaluated. The overall prescription rate and dosage were lower than the recommended levels. Hospitals with cardiac care had a significantly higher prescription rate than those without (p<0.001). Patients older than 75 years received significantly less therapy (p<0.001) and a lower dosage of RAAS antagonists (p<0.01) than younger patients. Younger patients were treated more intensively in hospitals with cardiac care (p<0.05). Patients aged >75 years were under-treated, independent of the hospital (n.s.). Multivariate analysis showed that age was the most influencing factor on survival (X2 15.5, p<0.0001). Additional influencing factors of long-term survival were type of the ward (X2 7.9, p<0.005) and pharmacologic treatment (X2 6.2, p<0.02).
Conclusion: Patients with chronic heart failure are still under-treated in clinical practice. Younger patients benefit from hospitals with specialized cardiac care. Elderly patients are obviously under-treated compared with younger patients. Of several clinical parameters, age was the only independent variable predicting long-term survival.
Key Words: Chronic heart failure • Therapy • Age • Specialty care
Received September 15, 2004; Revised November 23, 2004; Accepted November 25, 2004
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