Prescribing trends for management of congestive heart failure from 2002 to 2004

Crawford, Tonya; Segars, Larry W.; Rasu, Rafia S.

doi:10.1016/j.sapharm.2009.06.004

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Prescribing trends for management of congestive heart failure from 2002 to 2004

Tonya Crawford, Pharm.D.
- Department of Pharmacy, University of Illinois at Chicago Medical Center, Chicago, IL 60612, USA
Larry W. Segars, Pharm.D., Dr. P.H., F.C.C.P., B.C.P.S.
- Departments of Pharmacology/Microbiology & Preventive Medicine, Kansas City University of Medicine & Biosciences, Kansas City, MO 64106, USA
Rafia S. Rasu, M.Pharm., M.B.A., Ph.D.
- School of Pharmacy, University of Missouri-Kansas City, 4247 New Health Sciences Building, 2464 Charlotte Street, Kansas City, MO 64108, USA
- Corresponding author. Department of Pharmacy Practice and Administration, Schools of Pharmacy and Nursing, University of Missouri-Kansas City, 4247 New Health Sciences Building, 2464 Charlotte Street, Kansas City, MO 64108, USA. Tel.: +1 816 235 5498; fax: +1 816 235 6008.

published online 22 September 2009.
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Abstract

Background

The incidence and prevalence of the patients diagnosed with congestive heart failure (CHF) continues to grow in the United States. The use of prescription drugs is a vital part of the management of CHF, and pharmacological regimens may vary among patients.

Objectives

To examine the CHF prescription trends in the United States and to determine present prescribing patterns.

Methods

National Ambulatory Medical Care Survey and both divisions (outpatient and emergency department) of the National Hospital Ambulatory Medical Care Survey from 2002 to 2004 were used to acquire the appropriate data. All analyses used weighted data to represent national estimates. The unit of analysis was individual patient visits. Analysis of the data was accomplished using SPSS 14.0.2 and Stata/SE 9.2 statistical programs.

Results

During the 3 study years, 24,213,096 weighted visits were associated with a diagnosis of CHF. More than half (56.2%) of the study population were female; over 75% of the subjects were older than 65 years. Over one-quarter (27.3%; 6,618,208 visits) of CHF-related visits were not associated with being prescribed a CHF-related medication. Loop diuretics were the most commonly used medication (35%). Cardiovascular specialists (odds ratio [OR]=5.28; 95% confidence interval [CI]: 1.82-15.3; P=.002), general/family practice physicians (OR=4.5, 95% CI: 1.69-12.0; P=.003), and internal medicine physicians (OR=3.85, 95% CI: 1.39-10.7; P=.010) were more likely to prescribe CHF-related medication compared with other medical specialties. CHF patients who reside in the Northeast were more likely to receive CHF-related medications than other regions (Midwest OR=0.24; South OR=0.20; West OR=0.23; P<.05) of United States.

Conclusions

There were regional and medical specialty-related variations for prescribing CHF-related medications. The results from this study suggest a need for increased awareness of the benefit of CHF-related medications in the management of CHF. The increased implementation of the CHF management guidelines would improve overall patient care.

Keywords: Congestive heart failure, CHF, Heart failure, Prescription trends, Medication, Ambulatory care