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

BMC Cardiovascular Disorders, Jul 2012

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.

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

Ju-Young Kim Hwa-Jung Kim Sun-Young Jung Kwang-Il Kim Hong Ji Song Joong-Yub Lee Jong-Mi Seong 0 Byung-Joo Park 0 0 Department of Preventive Medicine, Seoul National University College of Medicine , Seoul , Korea 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. - Background Chronic heart failure (CHF) is a significant health burden worldwide and affects approximately 10% of individuals over 65 years of age [1]. The annual incidence of new heart failure events per 1,000 individuals is 15.2 for those aged 65 to 74, 31.7 for those aged 75 to 84, and 65.2 for those over 85 years of age [1]. Korea has an aging population, and the increased incidence of agerelated chronic diseases, including hypertension, diabetes, angina or other forms of cardiovascular disease, has negatively impacted the health and lives of elderly individuals. Heart failure accounts for a great deal of the morbidity and mortality in the population, and the estimated 5year age-adjusted mortality rate after a diagnosis of heart failure is 59% for men and 45% for women [2]. Evidence-based treatments that have been shown to decrease mortality rates [3,4] include angiotensin-2 receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACE-I), beta-blockers, and aldosterone antagonists. However, several studies have shown that these treatments are underutilized and are often prescribed at lower dose levels [5-10]. Factors related to the underutilization of evidence-based treatments include a lack of initiation or early discontinuation. The causes of this lack of initiation include the contraindication of drug use, lack of knowledge, lack of expertise for using these drugs, lack of time, and economic restraints [9]. However, in many cases, the reasons for underutilizing evidence-based therapy are unclear. Some evidence has been collected from several randomized clinical trials (RCTs), but most RCTs have limited generalizability for treatment options because these trials typically have strict inclusion and exclusion criteria. Euro Heart surveys found that among 10,701 heart failure patients, only 1,346 were eligible to participate in the majority of RCTs [11]. However, these findings do not explain the underutilization of evidence-based treatment in eligible individuals, and elderly CHF patients could significantly benefit from evidence-based treatment [12,13]. The causes of treatment underutilization may include the fear of polypharmacy, inaccurate perceptions concerning adverse effects, and contraindications. However, the mortality rate of patients with renal insufficiency was lower for those who received ACE-I, beta-blockers, statins, and aspirin [14]. Beta-blockers can be prescribed safely to patients with diabetes [15-17] and chronic obstructive pulmonary disease [18-21], and this treatment significantly decreases the morbidity and mortality caused by heart failure. Also, the utilization of evidencebased treat (...truncated)


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Ju-Young Kim, Hwa-Jung Kim, Sun-Young Jung, Kwang-Il Kim, Hong Song, Joong-Yub Lee, Jong-Mi Seong, Byung-Joo Park. Utilization of evidence-based treatment in elderly patients with chronic heart failure: using Korean Health Insurance claims database, BMC Cardiovascular Disorders, 2012, pp. 60, 12, DOI: 10.1186/1471-2261-12-60