© 2005 European Society of Cardiology
The relevance of comorbidities for heart failure treatment in primary care: A European survey
a Department of Clinical Pharmacology, University Medical Center Groningen Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
b Trial Coordination Centre (TCC), University Medical Center Groningen P.O. Box 30.001, 9700 RB, Groningen, The Netherlands
c Department of Medicine, Sahlgrenska University Hospital/Ostra S-416 85 Goteborg, Sweden
* Corresponding author. Tel.: +31 50 363 2820; fax: +31 50 363 2812. E-mail address: h.sturm{at}med.umcg.nl
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Abstract |
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Aim: To assess the impact of comorbidities on chronic heart failure (CHF) therapy.
Methods: The IMPROVEMENT-HF survey included 11,062 patients from 100 primary care practices in 14 European countries. The influence of patient characteristics on drug regimes was assessed with multinomial logistical regression.
Results: Combined drug regimes were given to 48% of CHF patients, consisting of 2.2 drugs on average. Patient characteristics accounted for 35%, 42% and 10% of the variance in one-, two- and three-drug regimes, respectively. Myocardial infarction (MI), atrial fibrillation (AF), diabetes, hypertension, and lung disease influenced prescribing most. AF made all combinations containing β-blockers more likely. Thus for single drug regimes, MI increased the likelihood for non-recommended β-blocker monotherapy (OR 1.3; 95% CI 1.2–1.4), while for combination therapy recommended regimes were most likely. For both hypertension and diabetes, ACE-inhibitors were the most likely single drug, while the most likely second drugs were β-blockers in hypertension and digoxin in diabetes.
Conclusions: Patient characteristics have a clear impact on prescribing in European primary care. Up to 56% of drug regimes were rational taking patient characteristics into account. Situations of insufficient prescribing, such as patients post MI, need to be addressed specifically.
Key Words: European survey • Chronic heart failure • Comorbidities • Prescribing • Primary care • IMPROVEMENT programme
Received August 24, 2004; Accepted March 21, 2005
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