PHARMACOLOGICAL MANAGEMENT OF HEART-FAILURE AMONG OLDER ADULTS BY OFFICE-BASED PHYSICIANS IN THE UNITED-STATES

BACKGROUND. Despite the recent availability of new classes of heart fa ilure medications, little is known about national patterns in the actu al physician utilization of these drugs. METHODS. In the National Ambu latory Medical Care Survey, 2912 US physicians reported on 16,968 offi ce visits in 1991-1992 with patients aged greater than or equal to 65 years. National estimates were obtained from weighted results that acc ounted for the complex sampling design. RESULTS. An estimated 8.3 mill ion (2.6%) office visits with older adults involved heart failure. Thi s included 9.3% of visits to cardiologists, 4.3% to internists, 3.5% t o general and family physicians, and 0.6% to other physicians. The mos t frequently prescribed medications during visits with these patients were diuretics (69%), digitalis compounds (46%), angiotensin-convertin g enzyme inhibitors (30%), and nitrates (19%). Internists and general and family physicians prescribed angiotensin-converting enzyme inhibit ors, digitalis compounds, and loop diuretics for patients with heart f ailure less often than did cardiologists. CONCLUSIONS. These are the f irst national surveillance estimates of physician practices in the man agement of heart failure. These data were collected during the same pe riod in which heart failure clinical trial results were initially publ ished, and they provide a baseline for monitoring the influence of rec ent clinical practice guidelines and professional education on changes in the management of heart failure by primary care physicians.