Clinical investigation: congestive heart failureTime trends in the use of β-blockers and other pharmacotherapies in older adults with congestive heart failure☆
Section snippets
Setting
The Cardiovascular Health Study is a community-based, prospective cohort study of risk factors for cardiovascular disease in the elderly. Participants were recruited from 1989 to 1990 from 4 US communities (Washington County, Md; Pittsburgh [Allegheny County], Pa; Forsyth County, NC; and Sacramento County, Calif), based on a randomly generated sampling frame from Health Care Financing Administration files.9, 10
Design
The study protocol consisted of a baseline clinic visit followed by semiannual
Results
Two hundred seventy-three participants had CHF at study entry, leaving 5615 participants, 84% white and 58% female, at risk for new-onset CHF. After 10 years of follow-up, 1033 incident CHF cases were diagnosed. Eight hundred eighty-nine (86%) were diagnosed in the inpatient setting, 141 (14%) in the outpatient setting, and 3 (<1%) had unclear or missing information on diagnosis setting. Characteristics of the 1033 participants at the visit immediately before the onset of CHF are listed in
Discussion
The findings of this study suggest that the pharmacologic treatment of incident and prevalent CHF in the community has shifted gradually over the past decade. Among incident cases, β-blocker use has increased steadily after 1989, with larger increases in use after 1995 among those with low ejection fraction or with coronary disease and/or hypertension. Renin-angiotensin inhibition in participants with incident CHF, especially those with hypertension, increased in prevalence throughout
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Cited by (39)
Trends in heart failure hospitalizations, patient characteristics, in-hospital and 1-year mortality: A population study, from 2000 to 2012 in Lombardy
2017, International Journal of CardiologyCitation Excerpt :Data from residents in Lombardy (about 10 million people) depict a two-faced reality: first, the actual, overall burden of HFHs, and inherent mortality, appear to be stable over more than a decade; and second, the incidence of new cases is decreasing, with a growing proportion of very old patients (aged ≥ 85 years) and a trend for reduction of in-hospital and 1-year mortality in the “youngest” patient cohort, i.e. in those aged < 75 years. These findings suggest that current strategies for prevention and treatment of cardiovascular conditions are effective in delaying the onset of HF and in improving outcomes in symptomatic patients, except for those aged 75 year and more [24–28]. So far, these changes did not impact significantly on the prevalence and mortality of acute, hospitalized HF.
Divergent trends in survival and readmission following a hospitalization for heart failure in the veterans affairs health care system 2002 to 2006
2010, Journal of the American College of CardiologyCitation Excerpt :Other studies of VA populations have noted increased use of beta-blockers and ACE inhibitors over time (6,7), and similar improvements in heart failure care have been seen in the general population. The CHS (Cardiovascular Health Study) of older Americans with heart failure found that use of ACE inhibitors increased 2.3% per year and beta-blocker use increased 2.4% per year from 1989 to 2000 (8). Additional studies are needed to determine how much of the decline in observed mortality rates can be explained by increased use of guideline-recommended medications.
The Medicare drug benefit (Part D) and treatment of heart failure in older adults
2010, American Heart JournalCitation Excerpt :Previous studies have shown that, before Part D, rates of prescribing of and adherence to pharmacotherapy regimens for heart failure were suboptimal.19,20 For example, only 43.6% of incident heart failure patients in the Cardiovascular Health Study were taking a β-blocker.20 We report a significant increase in β-blocker use among those without coverage in 2004-2005 who obtained Part D benefits (from 45% to 59%).
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Supported by contracts N01-HC-85079, N01-HC-85080, N01-HC-85081, N01-HC-85082, N01-HC-85083, N01-HC-85084, N01-HC-85085, N01-HC-85086, N01-HL-35129, and N01-HL-15103 from the National Heart, Lung, and Blood Institute and grant R01-AG-09556 from the National Institute on Aging.