TREATMENT PATTERNS FOR HEART-FAILURE IN A PRIMARY-CARE ENVIRONMENT

Little published information regarding current pharmacotherapeutic tre atment patterns for congestive heart failure (CHF) in nonacademic, amb ulatory care settings is available. We sought to assess, in a nonacade mic primary care environment, pharmacotherapeutic treatment patterns f or CHF with respect to consistency with clinical trial evidence and pu blished treatment guideline recommendations. Over an 18-month period, we examined CHF pharmacotherapy using a computerized, integrated clini cal diagnoses and prescription database from an outpatient community h ealthcare center without academic affiliations. We identified adult pa tients meeting contact criteria and with diagnosis of CHF by Internati onal Classification of Diseases (ICD-9-CM) coding and assessed prescri bed therapy as well as select comorbid conditions. Drugs of interest i ncluded those with known or suspected benefit or detriment and those w ith unproven benefit. An eligible group of 14,983 patients was identif ied, from which a cohort of 148 patients with CHF was selected. Forty- one percent of these 148 patients were prescribed an angiotensin conve rting enzyme (ACE) inhibitor, 34% digoxin, 12% diuretic, 12% hydralazi ne + nitrate, 20% inhaled beta-agonists, and 66% warfarin. Only 5% of patients were prescribed the combination of an ACE inhibitor, digoxin, and diuretic. Thirty-one percent had a comorbid diagnosis of atrial f ibrillation, of whom 44% were prescribed digoxin, 22% diltiazem, 15% b eta-blockers, 15% digoxin and diltiazem, 7% digoxin and a beta-blocker , and 33% warfarin. In general, recommended therapies for CHF appeared underutilized in this cohort, whereas those of unclear benefit and po tential detriment appeared overutilized. Although these results may no t be readily generalized to the entire healthcare system, they do sugg est a need for additional analysis and potential intervention.