Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
BMJ Open. 2021 Mar 2;11(3):e043290. doi: 10.1136/bmjopen-2020-043290.
We examined temporal heart failure (HF) prescription patterns in a large representative sample of real-world patients in the UK, using electronic health records (EHR).
From primary and secondary care EHR, we identified 85 732 patients with a HF diagnosis between 2002 and 2015. Almost 50% of patients with HF were women and the median age was 79.1 (IQR 70.2-85.7) years, with age at diagnosis increasing over time.
We found several trends in pharmacological HF management, including increased beta blocker prescriptions over time (29% in 2002-2005 and 54% in 2013-2015), which was not observed for mineralocorticoid receptor-antagonists (MR-antagonists) (18% in 2002-2005 and 18% in 2013-2015); higher prescription rates of loop diuretics in women and elderly patients together with lower prescription rates of angiotensin-converting enzyme inhibitors and/or angiotensin II receptor blockers, beta blockers or MR-antagonists in these patients; little change in medication prescription rates occurred after 6 months of HF diagnosis and, finally, patients hospitalised for HF who had no recorded follow-up in primary care had considerably lower prescription rates compared with patients with a HF diagnosis in primary care with or without HF hospitalisation.
In the general population, the use of MR-antagonists for HF remained low and did not change throughout 13 years of follow-up. For most patients, few changes were seen in pharmacological management of HF in the 6 months following diagnosis.
我们利用电子健康记录（EHR），在英国一个大型的真实患者代表性样本中，检查心力衰竭（HF）的时间用药模式。
我们从初级和二级保健 EHR 中，确定了 2002 年至 2015 年间患有 HF 的 85732 名患者。HF 患者中约有 50%为女性，中位年龄为 79.1（IQR 70.2-85.7）岁，且诊断时的年龄随时间推移而增加。
我们发现了一些 HF 药物治疗的趋势，包括β受体阻滞剂的处方量随时间增加（2002-2005 年为 29%，2013-2015 年为 54%），而醛固酮受体拮抗剂（MR 拮抗剂）则不然（2002-2005 年为 18%，2013-2015 年也为 18%）；女性和老年患者的噻嗪类利尿剂处方率较高，而这些患者的血管紧张素转换酶抑制剂和/或血管紧张素 II 受体阻滞剂、β受体阻滞剂或 MR 拮抗剂的处方率较低；HF 诊断后 6 个月的药物处方率几乎没有变化；最后，HF 住院患者如果在初级保健中没有记录的随访，其处方率明显低于初级保健中 HF 诊断且有或没有 HF 住院的患者。
在一般人群中，HF 患者使用 MR 拮抗剂的比例仍然较低，且在 13 年的随访期间并未改变。对于大多数患者，在诊断后 6 个月内，HF 的药物治疗管理几乎没有变化。
