The Retrospective Study of Etiologies and Prescribing Patterns of Patients with Left Ventricular Dysfunction

• Main Authors: Yu-Tzu Tung, 童宥慈
• Other Authors: Juey-Jen Hwang
• Format: Others
• Language: zh-TW
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/53193268791431659310

碩士 === 國立臺灣大學 === 臨床藥學研究所 === 94 === Since 1980, a number of guidelines and expert consensus documents for the management of chronic heart failure have been issued by different organizations and other related societies, however, many western studies suggested that the heart failure treatment in daily practice, showing a tendency toward underuse of recommended medications, has not been fully complied with these guidelines. In order to understand the local practice pattern, the aim of this study was to assess how patients with heart failure were managed at a medical center in Taiwan. With an attempt to analyze the etiologies and prescribing patterns of chronic heart failure in Taiwan, we retrospectively reviewed charts of 715 patients whose echocardiograms, acquired between Auguset 2003 and July 2004, showed left ventricular systolic dysfunction (LVEF≦40%). We found that coronary artery disease (59.4%) and hypertension (57.3%) were the most common possible etiologies. Diuretics (74.7%) were most frequently prescribed for patients. Prescription rate of ACEIs/ARBs was 59.1%, yet β-blockers were used only in 36% of patients. Daily dosages of ACEIs/ARBs and, particularly, β-blockers were below their respective recommended target doses on average. Multiple logistic regression analysis of these heart failure prescriptions indicated that the possible etiologies, age, co-morbid factors, renal function, and especially, the physicians’ subspecialties influenced the rate of prescription for recommended medications. That is, non-cardiologists were less likely to prescribe ACEIs/ARBs, β-blockers, and spironolactone (OR=0.199-0.638, p < 0.05) for patients with left ventricular systolic dysfunction. Four internationally renowned large placebo-controlled chronic-heart-failure trials including SOLVD, Val-HeFT, MERIT-HF, and RALES have proved ACEIs, ARBs, β-blockers, and spironolactone to be safe and effective, respectively. To further elucidate possible reasons for deviating from evidence-based life-saving pharmacotherapy, we have selected appropriate patients who also fulfilled the enrolment criteria of those randomized trials for analysis. We would like to identify, in real world, the proportion of patients eligible for evidenced-based treatment and the rate of appropriate prescription. Our data demonstrated that patients who fulfilled enrolment criteria of the four identified trials mentioned above were more likely to be treated with ACEIs/ARBs (71.1% of SOLVD-eligible patients vs. 52.7% in SOLVD-ineligible patients, p<.0001 and 65.4% of Val-HeFT-eligible patients vs. 57.1%, p=0.0834), β-blockers (41.9% of MERIT-HF-eligible patients vs. 34.9%, p=0.1941), and spironolactone (74.6% of RALES-eligible patients vs. 31.3%, p<.0001) than trial-ineligible patients. In addition, an attempt to search for reasonable explanations of the unsatisfactory prescription rate was made by analyzing chart records and laboratory data with disappointing results. In summary, the study offered the prescription patterns of patients with chronic heart failure at a medical center in Taiwan. However, the prescription of recommended medications including ACEIs/ARBs and, particularly, β-blockers remains low. Continued medical education of chronic heart failure treatment guidelines is still warranted to improve the dissemination and implementation current knowledge in daily practice for a better care of individual patients.