Effects of European Society of Cardiology guidelines on medication profiles after hospitalization for heart failure in 22,476 Dutch patients: From 2001 until 2015

Willemien J. Kruik-Kollöffel* (Corresponding Author), Gerard C.M. Linssen, H. Joost Kruik, Kris L.L. Movig, Edith M. Heintjes, Job van der Palen

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)499-510
Number of pages12
JournalHeart Failure Reviews
Volume24
Issue number4
Early online date8 Mar 2019
DOIs
Publication statusPublished - Jul 2019

Fingerprint

Mineralocorticoid Receptor Antagonists
Hospitalization
Heart Failure
Guidelines
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Prescriptions
Guideline Adherence
Diagnosis-Related Groups
Diuretics
Databases
Pharmacology

Keywords

  • UT-Hybrid-D
  • Guideline adherence
  • Health plan implementation
  • Heart failure
  • Pharmacoepidemiology
  • Practice guideline
  • Drug therapy

Cite this

Kruik-Kollöffel, Willemien J. ; Linssen, Gerard C.M. ; Kruik, H. Joost ; Movig, Kris L.L. ; Heintjes, Edith M. ; van der Palen, Job. / Effects of European Society of Cardiology guidelines on medication profiles after hospitalization for heart failure in 22,476 Dutch patients : From 2001 until 2015. In: Heart Failure Reviews. 2019 ; Vol. 24, No. 4. pp. 499-510.
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title = "Effects of European Society of Cardiology guidelines on medication profiles after hospitalization for heart failure in 22,476 Dutch patients: From 2001 until 2015",
abstract = "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.",
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Effects of European Society of Cardiology guidelines on medication profiles after hospitalization for heart failure in 22,476 Dutch patients : From 2001 until 2015. / Kruik-Kollöffel, Willemien J. (Corresponding Author); Linssen, Gerard C.M.; Kruik, H. Joost; Movig, Kris L.L.; Heintjes, Edith M.; van der Palen, Job.

In: Heart Failure Reviews, Vol. 24, No. 4, 07.2019, p. 499-510.

Research output: Contribution to journalReview articleAcademicpeer-review

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T1 - Effects of European Society of Cardiology guidelines on medication profiles after hospitalization for heart failure in 22,476 Dutch patients

T2 - From 2001 until 2015

AU - Kruik-Kollöffel, Willemien J.

AU - Linssen, Gerard C.M.

AU - Kruik, H. Joost

AU - Movig, Kris L.L.

AU - Heintjes, Edith M.

AU - van der Palen, Job

N1 - Springer deal

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N2 - 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.

AB - 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.

KW - UT-Hybrid-D

KW - Guideline adherence

KW - Health plan implementation

KW - Heart failure

KW - Pharmacoepidemiology

KW - Practice guideline

KW - Drug therapy

U2 - 10.1007/s10741-019-09777-2

DO - 10.1007/s10741-019-09777-2

M3 - Review article

AN - SCOPUS:85062774783

VL - 24

SP - 499

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JO - Heart Failure Reviews

JF - Heart Failure Reviews

SN - 1382-4147

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ER -