OBJECTIVES: To examine trends and predictors of prescription medications on discharge after first (index) hospitalisation for heart failure (HF), and the effect on all-cause mortality of evidence-based therapy. DESIGN: A retrospective multicentre cohort study, with medical record review. SETTING: Three tertiary-care hospitals in Perth, Western Australia. PATIENTS: WA Hospital Morbidity Data were used to identify a random sample of 1006 patients with an index admission to hospital for HF between 1996 and 2006. MAIN OUTCOME MEASURES: Proportion of patients prescribed evidence-based therapy for HF on discharge from hospital; and 1-year all-cause mortality. RESULTS: Among 944 patients surviving to hospital discharge, the prescription rate of angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) (74.3%) and loop diuretics (85.5%) remained high over the study period, whereas that of beta-blockers and spironolactone increased (10.5% to 51.3% and 1.4% to 23.3%, respectively), and digoxin prescription decreased (38.1% to 20.7%). The temporal trends in use of beta-blockers, spironolactone and digoxin were in line with clinical trial evidence. Age > or = 75 years was a significant, negative predictor of beta-blocker and spironolactone prescription. In-hospital echocardiography, performed in 53% of patients, was associated with a significantly greater likelihood of treatment with ACE inhibitors/ARBs, beta-blockers and spironolactone. Both ACE inhibitors/ARBs and beta-blockers prescribed on discharge were associated with a lower adjusted hazard ratio (HR) for mortality at 1-year (HR, 0.71; P = 0.003; and HR, 0.68; P = 0.002, respectively). CONCLUSION: ACE inhibitors/ARBs and beta-blockers, prescribed during initial hospitalisation for HF, are associated with improved long-term survival. Therapy became more evidence based over the study period, but echocardiography, an important predictor of evidence-based therapy, was underutilised.
OBJECTIVES: To examine trends and predictors of prescription medications on discharge after first (index) hospitalisation for heart failure (HF), and the effect on all-cause mortality of evidence-based therapy. DESIGN: A retrospective multicentre cohort study, with medical record review. SETTING: Three tertiary-care hospitals in Perth, Western Australia. PATIENTS: WA Hospital Morbidity Data were used to identify a random sample of 1006 patients with an index admission to hospital for HF between 1996 and 2006. MAIN OUTCOME MEASURES: Proportion of patients prescribed evidence-based therapy for HF on discharge from hospital; and 1-year all-cause mortality. RESULTS: Among 944 patients surviving to hospital discharge, the prescription rate of angiotensin-converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARBs) (74.3%) and loop diuretics (85.5%) remained high over the study period, whereas that of beta-blockers and spironolactone increased (10.5% to 51.3% and 1.4% to 23.3%, respectively), and digoxin prescription decreased (38.1% to 20.7%). The temporal trends in use of beta-blockers, spironolactone and digoxin were in line with clinical trial evidence. Age > or = 75 years was a significant, negative predictor of beta-blocker and spironolactone prescription. In-hospital echocardiography, performed in 53% of patients, was associated with a significantly greater likelihood of treatment with ACE inhibitors/ARBs, beta-blockers and spironolactone. Both ACE inhibitors/ARBs and beta-blockers prescribed on discharge were associated with a lower adjusted hazard ratio (HR) for mortality at 1-year (HR, 0.71; P = 0.003; and HR, 0.68; P = 0.002, respectively). CONCLUSION:ACE inhibitors/ARBs and beta-blockers, prescribed during initial hospitalisation for HF, are associated with improved long-term survival. Therapy became more evidence based over the study period, but echocardiography, an important predictor of evidence-based therapy, was underutilised.
Authors: Tiew-Hwa Katherine Teng; Judith M Katzenellenbogen; Joseph Hung; Matthew Knuiman; Frank M Sanfilippo; Elizabeth Geelhoed; Michael Hobbs; Sandra C Thompson Journal: BMJ Open Date: 2014-05-02 Impact factor: 2.692
Authors: Tiew-Hwa Katherine Teng; Judith M Katzenellenbogen; Joseph Hung; Matthew Knuiman; Frank M Sanfilippo; Elizabeth Geelhoed; Dawn Bessarab; Michael Hobbs; Sandra C Thompson Journal: Int J Equity Health Date: 2015-08-12
Authors: Pupalan Iyngkaran; Jeff Tinsley; David Smith; Mark Haste; Kangaharan Nadarajan; Marcus Ilton; Malcolm Battersby; Simon Stewart; Alex Brown Journal: BMJ Open Date: 2014-01-29 Impact factor: 2.692
Authors: Pupalan Iyngkaran; Nadarajan Kangaharan; Hendrik Zimmet; Margaret Arstall; Rob Minson; Merlin C Thomas; Peter Bergin; John Atherton; Peter MacDonald; David L Hare; John D Horowitz; Marcus Ilton Journal: Curr Cardiol Rev Date: 2016
Authors: Pupalan Iyngkaran; Danny Liew; Peter McDonald; Merlin C Thomas; Christopher Reid; Derek Chew; David L Hare Journal: Curr Cardiol Rev Date: 2016