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

BMC Cardiovascular Disorders

Byung-Joo Park⁴  Jong-Mi Seong⁴  Joong-Yub Lee¹  Hong Ji Song⁵  Kwang-Il Kim⁷  Sun-Young Jung²  Hwa-Jung Kim³  Ju-Young Kim⁶ 

[1] Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea;Korea Institute of Drug Safety and Risk Management, Seoul, Korea;Department of Clinical Epidemiology and Biostatics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea;Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea;Department of Family Medicine and Health Promotion Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Korea;Department of Family Medicine, Seoul National University Bundang Hospital, Seoul, Korea;Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea

关键词: Beta-adrenergic blockers;    Angiotensin-converting enzyme antagonists;    Type 2 angiotensin receptor antagonists;    Elderly;    Drug utilization evaluation;    Congestive heart failure;   

Others  :  1084654
DOI  :  10.1186/1471-2261-12-60

 received in 2012-02-03, accepted in 2012-07-12,  发布年份 2012

【 摘 要 】

Background

Chronic heart failure accounts for a great deal of the morbidity and mortality in the aging population. Evidence-based treatments include angiotensin-2 receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACE-I), beta-blockers, and aldosterone antagonists. Underutilization of these treatments in heart failure patients were frequently reported, which could lead to increase morbidity and mortality. The aim of this study was to evaluate the utilization of evidence-based treatments and their related factors for elderly patients with chronic heart failure.

Methods

This is retrospective observational study using the Korean National Health Insurance claims database. We identified prescription of evidence based treatment to elderly patients who had been hospitalized for chronic heart failure between January 1, 2005, and June 30, 2006.

Results

Among the 28,922 elderly patients with chronic heart failure, beta-blockers were prescribed to 31.5%, and ACE-I or ARBs were prescribed to 54.7% of the total population. Multivariable logistic regression analyses revealed that the prescription from outpatient clinic (prevalent ratio, 4.02, 95% CI 3.31–4.72), specialty of the healthcare providers (prevalent ratio, 1.26, 95% CI, 1.12–1.54), residence in urban (prevalent ratio, 1.37, 95% CI, 1.23–1.52) and admission to tertiary hospital (prevalent ratio, 2.07, 95% CI, 1.85–2.31) were important factors associated with treatment underutilization. Patients not given evidence-based treatment were more likely to experience dementia, reside in rural areas, and have less-specialized healthcare providers and were less likely to have coexisting cardiovascular diseases or concomitant medications than patients in the evidence-based treatment group.

Conclusions

Healthcare system factors, such as hospital type, healthcare provider factors, such as specialty, and patient factors, such as comorbid cardiovascular disease, systemic disease with concomitant medications, together influence the underutilization of evidence-based pharmacologic treatment for patients with heart failure.

【 授权许可】

   
2012 Kim et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1 .

Figure 2 .

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