Heart failure epidemiology and treatment in primary care: a retrospective cross-sectional study - PubMed (original) (raw)

Heart failure epidemiology and treatment in primary care: a retrospective cross-sectional study

Yael Rachamin et al. ESC Heart Fail. 2021 Feb.

Abstract

Aims: Heart failure is one of the leading causes of morbidity and mortality worldwide, but little is known on heart failure epidemiology and treatment in primary care. This study described patients with heart failure treated by general practitioners, with focus on drug prescriptions and especially on the only specific treatment for heart failure with reduced ejection fraction, namely sacubitril/valsartan.

Methods and results: This was a retrospective cross-sectional study using data from an electronic medical record database of Swiss general practitioners from 2016 to 2019. Multilevel logistic regression was used to find determinants of sacubitril/valsartan prescription; odds ratios (ORs) and 95% confidence intervals (CIs) were reported. We identified 1288 heart failure patients (48.5% women; age: median 85 years, interquartile range 77-90 years) by means of diagnosis code, representing 0.5% of patients consulting a general practitioner during the observation period. About 73.6% received a renin-angiotensin-aldosterone system inhibitor, 67.8% a beta-blocker, 34.6% a calcium channel blocker, 86.1% a diuretic, and 40.1% another cardiac drug. Sacubitril/valsartan was prescribed in 6% predominantly male patients (OR 2.10, CI 1.25-3.84), of younger age (OR 0.59 per increase in 10 years, CI 0.49-0.71), with diabetes mellitus (OR 1.76, CI 1.07-2.90). The recommended starting dose for sacubitril/valsartan was achieved in 67.1% and the target dose in 28.6% of patients.

Conclusions: Prevalence of heart failure among patients treated by general practitioners was low. Considering the disease burden and association with multimorbidity, awareness of heart failure in primary care should be increased, with the aim to optimize heart failure therapy.

Keywords: Drug treatment; General practitioners; Heart failure; Monitoring; Primary care; Sacubitril/valsartan.

© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.

PubMed Disclaimer

Conflict of interest statement

A.J.F. reports fees from Alnylam, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Fresenius, Imedos Systems, Medtronic, Mundipharma, Novartis, Pfizer, Roche, Vifor, and Zoll. Y.R., R.M., T.R., and C.C. declare that they have no conflict of interest.

Figures

Figure 1

Figure 1

Study flowchart of HF patient selection. Of patients visiting an ICPC‐2 coding FIRE GP in 2016–2019, all patients with ICPC‐2 K77 code were included. GP, general practitioner; HF, heart failure.

Figure 2

Figure 2

Patients with renin–angiotensin–aldosterone system (RAAS) inhibitors (R), calcium channel blockers (C), or diuretics (D): treatment combinations. The area is proportional to the number of corresponding patients (total area: patients with at least one of the three drug groups, n = 1188). Most of the patients were prescribed combinations of the three drug groups, such as RAAS inhibitors plus diuretics (R‐D, 43.4% of patients) or all three groups (R‐D‐C, 30.9% of patients). The figure was created with the eulerAPE software.44

References

    1. Metra M, Teerlink JR. Heart failure. The Lancet 2017; 390: 1981–1995. - PubMed
    1. Ambrosy AP, Fonarow GC, Butler J, Chioncel O, Greene SJ, Vaduganathan M, Nodari S, Lam CSP, Sato N, Shah AN, Gheorghiade M. The global health and economic burden of hospitalizations for heart failure: lessons learned from hospitalized heart failure registries. J Am Coll Cardiol 2014; 63: 1123–1133. - PubMed
    1. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González‐Juanatey JR, Harjola V‐P, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P, Group ESD . 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37: 2129–2200. - PubMed
    1. van der Meer P, Gaggin HK, Dec GW. ACC/AHA versus ESC guidelines on heart failure: JACC guideline comparison. J Am Coll Cardiol 2019; 73: 2756–2768. - PubMed
    1. Yusuf S, Pfeffer MA, Swedberg K, Granger CB, Held P, McMurray JJ, Michelson EL, Olofsson B, Ostergren J. Effects of candesartan in patients with chronic heart failure and preserved left‐ventricular ejection fraction: the CHARM‐Preserved Trial. The Lancet 2003; 362: 777–781. - PubMed

Publication types

MeSH terms

Substances

LinkOut - more resources