Purpose: Heart failure (HF) is a complex clinical syndrome highly prevalent among the elderly. Evidence-based (EB) treatment with ACEIs/ARBs or β-blockers is the mainstay of secondary prevention after HF. The aim of this study is to examine the influence of patients' characteristics and organisational determinants on hospital readmission and on initiation/adherence to EB medications. Methods: The study population comprised patients resident in a Local Health Authority discharged from any Italian hospital between 1/1/2008 and 31/12/2010 with a primary diagnosis of HF, identified through the hospital discharge records database. The outcomes of interests were the rate of hospital readmissions for HF at 1 year after discharge, the proportion of patients with at least 1 prescription of ACEIs/ARBs or β-blockers within 90 days of discharge (drug initiators) and the proportion of patients with at least 2/4 prescriptions of ACEIs/ARBs or β-blockers within 180/365 days of discharge (adherent patients). Differences in adherence were examined in relation to patients', general practitioners (GPs) and primary care units (PCUs) characteristics using a multilevel modified Poisson regression model. Results: The study sample includes 7716 patients, 56% female, with a mean age of 81±10 years. The readmission rate for HF was 27%. Older patients had a higher risk of readmission, while those treated by GPs practicing in rural area (RR=0.88; 95% CI=0.79–0.97) and those referred to PCUs with HF clinical pathway (RR=0.84; 95% CI=0.77–0.93) had a lower readmission rate. The proportion of patients with ≥1 prescription of ACEIs/ARBs was 65% at 90 days and 53% at 1 year from discharge. Lowland GPs' patients were more likely to initiate ACEIs/ARBs. Lower initiation and adherence were found in women (RR=0.95; 95% CI=0.92–0.99) and older patients (RR=0.70; 95% CI=0.65–0.77). Moreover the proportion of patients treated with β-blockers was 54% at 90 days and 43% at 1 year from discharge. Older patients were less likely to initiate treatment and to be adherent. Patients of GPs practicing in mountain area and patients referred to PCUs with implemented HF clinical pathways were significantly more likely to receive a prescription of β-blockers. Conclusions: Our results suggest that older patients are less prone to initiate and to be adherent to secondary prevention medications after HF. Physicians should be encouraged to implement strategies aimed to increase patients' initiation and adherence to EB drug treatments.
Lenzi J., Castaldini I., Avaldi V.M., Rucci P., Protonotari A., Di Pasquale G., et al. (2014). Good management of patients with heart failure: what matters?. European society of cardiology.
Good management of patients with heart failure: what matters?
LENZI, JACOPO;AVALDI, VERA MARIA;RUCCI, PAOLA;FANTINI, MARIA PIA
2014
Abstract
Purpose: Heart failure (HF) is a complex clinical syndrome highly prevalent among the elderly. Evidence-based (EB) treatment with ACEIs/ARBs or β-blockers is the mainstay of secondary prevention after HF. The aim of this study is to examine the influence of patients' characteristics and organisational determinants on hospital readmission and on initiation/adherence to EB medications. Methods: The study population comprised patients resident in a Local Health Authority discharged from any Italian hospital between 1/1/2008 and 31/12/2010 with a primary diagnosis of HF, identified through the hospital discharge records database. The outcomes of interests were the rate of hospital readmissions for HF at 1 year after discharge, the proportion of patients with at least 1 prescription of ACEIs/ARBs or β-blockers within 90 days of discharge (drug initiators) and the proportion of patients with at least 2/4 prescriptions of ACEIs/ARBs or β-blockers within 180/365 days of discharge (adherent patients). Differences in adherence were examined in relation to patients', general practitioners (GPs) and primary care units (PCUs) characteristics using a multilevel modified Poisson regression model. Results: The study sample includes 7716 patients, 56% female, with a mean age of 81±10 years. The readmission rate for HF was 27%. Older patients had a higher risk of readmission, while those treated by GPs practicing in rural area (RR=0.88; 95% CI=0.79–0.97) and those referred to PCUs with HF clinical pathway (RR=0.84; 95% CI=0.77–0.93) had a lower readmission rate. The proportion of patients with ≥1 prescription of ACEIs/ARBs was 65% at 90 days and 53% at 1 year from discharge. Lowland GPs' patients were more likely to initiate ACEIs/ARBs. Lower initiation and adherence were found in women (RR=0.95; 95% CI=0.92–0.99) and older patients (RR=0.70; 95% CI=0.65–0.77). Moreover the proportion of patients treated with β-blockers was 54% at 90 days and 43% at 1 year from discharge. Older patients were less likely to initiate treatment and to be adherent. Patients of GPs practicing in mountain area and patients referred to PCUs with implemented HF clinical pathways were significantly more likely to receive a prescription of β-blockers. Conclusions: Our results suggest that older patients are less prone to initiate and to be adherent to secondary prevention medications after HF. Physicians should be encouraged to implement strategies aimed to increase patients' initiation and adherence to EB drug treatments.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
