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

BMC Cardiovascular Disorders

Research Article

Hwa-Jung Kim¹  Hong Ji Song²  Ju-Young Kim³  Kwang-Il Kim⁴  Jong-Mi Seong⁵  Byung-Joo Park⁵  Sun-Young Jung⁶  Joong-Yub Lee⁷ 

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

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

DOI  :  10.1186/1471-2261-12-60

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

来源: Springer

【 摘 要 】

BackgroundChronic 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.MethodsThis 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.ResultsAmong 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.ConclusionsHealthcare 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】

Unknown   
© Kim et al.; licensee BioMed Central Ltd. 2012. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.