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Assistant Professor, College of Pharmacy, University of Arizona, Tucson, AZ; Investigator, Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona
Assistant Research Scientist, Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona
Associate Professor, College of Pharmacy, University of Arizona; Investigator, Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona
Professor, College of Pharmacy, University of Arizona; Investigator, Center for Health Outcomes and PharmacoEconomic Research, College of Pharmacy, University of Arizona
Assistant Professor, College of Medicine, University of Arizona
Professor, College of Medicine, University of Arizona
Reprints: Dr. Skrepnek, College of Pharmacy, University of Arizona, 1703 E. Mabel St., Tucson, AZ 85721-0207, fax 520/626-7355, skrepnek{at}pharmacy.arizona.edu
BACKGROUND: Inappropriate medication use in patients with heart failure (HF) presents challenges in providing optimal, evidence-based care.
OBJECTIVE: To evaluate the incremental differences of concurrent and persistent use of angiotensin-converting enzyme (ACE) inhibitors, ß-blockers, loop diuretics, and digoxin on the one-year, all-cause risk of hospitalization and total healthcare costs associated with treatment of HF in patients enrolled in a managed care organization within the US.
METHODS: A retrospective database analysis was conducted spanning from January 1, 1997, to December 31, 1999. Multivariate regression methods were used to examine the association between treatment regimens and hospitalizations or costs after controlling for patient demographics and risk factors.
RESULTS: Of the 1903 patients meeting inclusion criteria, 32.3% (n =
615) received none of the 4 HF agents studied and were associated with a 2.5
times greater risk (p 
0.001) of hospitalization and 43.6% higher (p
0.001) total costs compared with all other patients with HF. Comparatively,
13.9% (n = 264) utilized the HF medications investigated for at least 6
months. Of those with persistent use of 
3 agents, approximate decreases in
hospitalizations were noted of 80% (p 0.001) and total costs of 70% (p
0.001) relative to patients receiving no HF therapy.
CONCLUSIONS: A substantial portion of patients with HF may be receiving suboptimal pharmacotherapeutic care in real-world practice settings, potentially incurring large increases in hospitalizations and total costs. Quality improvement initiatives should seek to identify and manage those not being treated according to guideline recommendations.
Key Words: costs, heart failure; angiotensin-converting enzyme inhibitors, ß-blockers, digoxin, loop diuretics
Published Online, October 11, 2005. www.theannals.com, DOI 10.1345/aph.1G124
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