Effects of European Society of Cardiology guidelines on medication profiles after hospitalization for heart failure in 22,476 Dutch patients: from 2001 until 2015
- 225 Downloads
Prescriber adherence to guideline-recommended medication in patients with heart failure (HF) in clinical practice is suboptimal. We analyzed how evolving guideline recommendations influenced medication profiles after a first HF hospitalization. We extracted medication profiles from the Dutch PHARMO Database Network for 22,476 patients with a diagnosis of HF at hospital discharge between 2001 and 2015. The percentage of patients prescribed the combination of a beta-blocker (BB) and an angiotensin-converting-enzyme inhibitor (ACEI) or angiotensin-receptor blocker (ARB) increased from 24 to approximately 45% within this 15-year period. The percentage of patients who also used a mineralocorticoid-receptor antagonist (MRA) reached approximately 20%. The probability of being prescribed these combinations decreased with increasing age. As a consequence of the policy change in the ESC guideline 2001, the use of BB increased from less than 40% in 2001 to about 70% by 2015. The percentage of patients prescribed an ACEI and/or an ARB, an MRA, or a diuretic was about stable, at respectively 63%, 37%, and 82%. Although the 2012 ESC guideline also advised MRA in the New York Heart Association (NYHA) class II, there was no increase in MRA prescriptions. Compliance with the ESC guidelines varied for the individual recommendations. Remarkably, there was no significant increase in MRA prescriptions. At the same time, developments were demonstrated, which were not instigated by the guidelines, like the shift from ACEI to ARB. Although the exact HF classification of our patients was unknown, given a relatively stable case mix, our data provide insight into “real-world” pharmacological management.
KeywordsHeart failure Drug therapy Pharmacoepidemiology Guideline adherence Practice guideline Health plan implementation
The authors would like to thank all the healthcare providers contributing information to the PHARMO Database Network.
Compliance with ethical standards
Conflict of interests
E.M. Heintjes is an employee of the PHARMO Institute for Drug Outcomes Research. This independent research institute performs financially supported studies for government and related healthcare authorities and several pharmaceutical companies. This study, however, was not supported by a pharmaceutical company. W.J. Kruik-Kollöffel, G.C.M. Linssen, H.J. Kruik, K.L.L. Movig, and J. van der Palen have no conflicts of interest or financial ties to disclose.
For this kind of study, formal consent is not required.
- 1.Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, 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 (2016) 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 J Heart Fail 18(8):891–975CrossRefGoogle Scholar
- 3.Eschalier R, Chenaf C, Mulliez A, Yalioua A, Clerfond G, Authier N, Vorilhon C, Citron B, Pereira B, Jean F, Souteyrand G, Motreff P, Eschalier A, Lusson JR (2015) Impact of clinical characteristics and management on the prognosis of unselected heart failure patients. Cardiovasc Drugs Ther 29(1):89–98. https://doi.org/10.1007/s10557-015-6572-y CrossRefGoogle Scholar
- 4.Gilstrap LG, Fonarow GC, Desai AS, Liang L, Matsouaka R, DeVore AD, Smith EE, Heidenreich P, Hernandez AF, Yancy CW, Bhatt DL (2017) Initiation, continuation, or withdrawal of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and outcomes in patients hospitalized with heart failure with reduced ejection fraction. J Am Heart Assoc 6(2):e004675CrossRefGoogle Scholar
- 5.Koudstaal S, Pujades-Rodriguez M, Denaxas S, Gho JMIH, Shah AD, Yu N, Patel RS, Gale CP, Hoes AW, Cleland JG, Asselbergs FW, Hemingway H (2017) Prognostic burden of heart failure recorded in primary care, acute hospital admissions, or both: a population-based linked electronic health record cohort study in 2.1 million people. Eur J Heart Fail 19(9):1119–1127CrossRefGoogle Scholar
- 6.Maggioni AP, Anker SD, Dahlstrom U, Filippatos G, Ponikowski P, Zannad F, Amir O, Chioncel O, Crespo-Leiro M, Drozdz J, Erglis A, Fazlibegovic E, Fonseca C, Fruhwald F, Gatzov P, Goncalvesova E, Hassanein M, Hradec J, Kavoliuniene A, Lainscak M, Logeart D, Merkely B, Metra M, Persson H, Seferovic P, Temizhan A, Tousoulis D, Tavazzi L (2013) Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12,440 patients of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail 15(10):1173–1184CrossRefGoogle Scholar
- 8.Task Force of the Working Group on Heart Failure of the European Society of Cardiology (1997) The treatment of heart failure. Eur Heart J 18(5):736–753. https://doi.org/10.1093/oxfordjournals.eurheartj.a015339 CrossRefGoogle Scholar
- 10.Swedberg K, Cleland J, Dargie H, Drexler H, Follath F, Komajda M, Tavazzi L, Smiseth OA, Gavazzi A, Haverich A, Hoes A, Jaarsma T, Korewicki J, Lévy S, Linde C, Lopez-Sendon JL, Nieminen MS, Piérard L, Remme WJ (2005) Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): the task force for the diagnosis and treatment of chronic heart failure of the European Society of Cardiology. Eur Heart J 26(11):1115–1140. https://doi.org/10.1093/eurheartj/ehi204 CrossRefGoogle Scholar
- 11.Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, Strömberg A, van Veldhuisen DJ, Atar D, Hoes AW, Keren A, Mebazaa A, Nieminen M, Priori SG, Swedberg K (2008) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the task force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J 29(19):2388–2442. https://doi.org/10.1093/eurheartj/ehn309 CrossRefGoogle Scholar
- 12.McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez-Sanchez MA, Jaarsma T, Køber L, Lip GYH, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PTT, Voors AA, Zannad F, Zeiher A (2012) ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 33(14):1787–1847. https://doi.org/10.1093/eurheartj/ehs104 CrossRefGoogle Scholar
- 14.Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Colvin MM, Drazner MH, Filippatros GS, Fonarow GC, Givertz MM, Hollenberg SM, Lindenfeld JA (2017) 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the Heart Failure Society of America. J Am Coll Cardiol 70(6):776–803. https://doi.org/10.1016/j.jacc.2017.04.025 CrossRefGoogle Scholar
- 16.Pharmo. PHARMO Database Network. https://www.pharmo.nl/what-we-have/pharmo-database-network/. Accessed 4 November 2018
- 18.Tavazzi L, Senni M, Metra M, Gorini M, Cacciatore G, Chinaglia A, Di Lenarda A, Mortara A, Oliva F, Maggioni AP (2013) Multicenter prospective observational study on acute and chronic heart failure: one-year follow-up results of IN-HF (Italian Network on Heart Failure) outcome registry. Circ Heart Fail 6(3):473–481CrossRefGoogle Scholar
- 19.The Drug Information System of National Health Care Institute. https://www.gipdatabank.nl/ Accessed 4 November 2018
- 20.European Medicines Agency (EMA). PRAC recommends against combined use of medicines affecting the renin-angiotensin (RAS) system, 11 April 2014. http://www.ema.europa.eu/ema/index.jsp?curl=pages/news_and_events/news/2014/04/news_detail_002066.jsp&mid=WC0b01ac058004d5c1. Accessed 4 November 2018
- 21.Packer M, Fowler MB, Roecker EB, Coats AJ, Katus HA, Krum H, Mohacsi P, Rouleau JL, Tendera M, Staiger C, Holcslaw TL, Amann-Zalan I, DeMets DL (2002) Effect of carvedilol on the morbidity of patients with severe chronic heart failure: results of the carvedilol prospective randomized cumulative survival (COPERNICUS) study. Circulation 106(17):2194–2199CrossRefGoogle Scholar
- 23.Flather MD, Shibata MC, Coats AJ, van Veldhuisen DJ, Parkhomenko A, Borbola J, Cohen-Solal A, Dumitrascu D, Ferrari R, Lechat P, Soler-Soler J, Tavazzi L, Spinarova L, Toman J, Böhm M, Anker SD, Thompson SG, Poole-Wilson PA (2005) Randomized trial to determine the effect of nebivolol on mortality and cardiovascular hospital admission in elderly patients with heart failure (SENIORS). Eur Heart J 26(3):215–225. https://doi.org/10.1093/eurheartj/ehi115 CrossRefGoogle Scholar
- 25.Ferreira JP, Rossignol P, Machu JL, Sharma A, Girerd N, Anker SD, Cleland JG, Dickstein K, Filippatos G, Hillege HL, Lang CC, ter Maaten JM, Metra M, Ng L, Ponikowski P, Samani NJ, van Veldhuisen DJ, Zwinderman AH, Voors A, Zannad F (2017) Mineralocorticoid receptor antagonist pattern of use in heart failure with reduced ejection fraction: findings from BIOSTAT-CHF. Eur J Heart Fail 19(10):1284–1293CrossRefGoogle Scholar
- 26.Savarese G, Carrero JJ, Pitt B, Anker SD, Rosano GMC, Dahlstrom U, Lund LH (2018) Factors associated with underuse of mineralocorticoid receptor antagonists in heart failure with reduced ejection fraction: an analysis of 11 215 patients from the Swedish Heart Failure Registry. Eur J Heart Fail 20(9):1326–1334CrossRefGoogle Scholar
- 29.Komajda M, Hanon O, Hochadel M, Lopez-Sendon JL, Follath F, Ponikowski P, Harjola VP, Drexler H, Dickstein K, Tavazzi L, Nieminen M (2009) Contemporary management of octogenarians hospitalized for heart failure in Europe: euro heart failure survey II. Eur Heart J 30(4):478–486. https://doi.org/10.1093/eurheartj/ehn539 CrossRefGoogle Scholar
- 30.Brunner-La Rocca HP, Linssen GC, Smeele FJ, van Drimmelen AA, Schaafsma HJ, Westendorp PH, Rademaker PC, van de Kamp HJ, Hoes AW, Brugts JJ (2019) Contemporary drug treatment of chronic heart failure with reduced ejection fraction: the CHECK-HF registry. JACC Heart Fail 7(1):13–21CrossRefGoogle Scholar
- 31.British Society for Heart Failure. National Heart Failure Audit, April 2014–March 2015. https://www.ucl.ac.uk/nicor/audits/heartfailure/documents/annualreports/heartfailurepublication14_15. Accessed 4 November 2018