[Long-term trends in drug prescription for hospitalized patients with congestive heart failure. Influence of type of dysfunction].

INTRODUCTION AND OBJECTIVES

To evaluate changes in drug prescription during 1991-2002 in patients hospitalized for congestive heart failure (CHF) with preserved or depressed left ventricular (LV) systolic function.

PATIENTS AND METHOD

A total of 1252 CHF patients (mean age, 69.4 (11.7) years; 61.3% male) hospitalized in a cardiology department were studied. Ischemic heart disease was present in 616 (49.2%), hypertension in 693 (55.4%), and diabetes in 335 (26.8%). Some 498 (39.8%) had preserved LV systolic function, defined as an echocardiographically determined ejection fraction > or =50% at admission. Pharmacotherapy at hospital discharge was recorded for all patients.

RESULTS

The changes in drug prescription observed in CHF patients with preserved LV systolic function paralleled those in patients with depressed LV systolic function. Change was influenced by the publication of major clinical trials on CHF and depressed LV systolic function. Consequently, the use of angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, beta-blockers, and spironolactone progressively increased during follow-up for both types of CHF. Diuretics were prescribed for more than 70% of patients, with the rate being higher in those with depressed LV systolic function. Digoxin use decreased markedly in patients with preserved LV systolic function.

CONCLUSIONS

An increase in the prescription of drugs with proven effects on mortality and morbidity in patients with CHF was observed. Nevertheless, beta-blocker and spironolactone use remains suboptimal. The trend seen after hospitalization in CHF patients with preserved LV systolic function was similar, though slightly less marked.