Utilization of evidence based medications in patients prior to the time of first referral to outpatient heart failure clinics of the Canadian Heart Failure Network (CHFN)

Abstract:

Introduction: The modern treatment of HF is driven by large randomized clinical trials demonstrating superiority of some drugs over previous standards. These drugs have been recommended in clinical guideline recommendations which are used a basis for quality of care. To determine the extent of uptake of such recommendations, we analyzed data in the longitudinal prospective database of the CHFN's 28 specialized HF outpatient clinics. The member clinics represent university teaching hospitals, community hospitals, and group practices.
Methods and Results: Percent share and average dose for each medication within 3 major drug classes were calculated over five 2 year periods, 1999 to 2008. Data on the 3 most prescribed ACEi's (ramipril, enalapril, lisinopri) and BB's (carvedilol, metoprolol, bisoprolol), as well as spironolactone, are presented. These ACEi's represented 83.8% of all ACEi's prescribed and these BB's represented 93.3% of all BB's prescribed. Ramipril and carvedilol were the most commonly prescribed surges in their classes.
Conclusions: The ACEi's and BB's most commonly used to reflect those in the landmark clinical trials to prevent or treat HF. IN Canada, ramipril was the preferred choice, increasing over time at clinical trial doses. Carvedilol was the preferred BB with bisoprolol gaining quickly but both were below target doses. These data represent practice at the time of first CHFN data entry showing early uptake of EB prescribing before publication os some national guidelines.