A survey of outpatient management of elderly heart failure patients in Poland—treatment patterns

Background: Despite the fact that heart failure constitutes a major health problem there are only limited data regarding pharmacotherapy along with characterization and prognosis of heart failure in the community. Aim: The aim of this study was to investigate treatment pattern in ambulatory patients with heart failure. Methods: The study is a cross-country epidemiological survey, based on registration, by 417 participating physicians, 50 consecutive ambulatory patients aged ≥65 years seeking medical care for any cause. Results: From a total of 19,877 individuals, 10,579 patients (3901 men and 6678 women, 53% of total) were diagnosed with HF. Therapy with angiotensin converting enzyme inhibitors was recommended in 68%, long acting nitrates in 62%, diuretics in 55%, cardiac glycosides in 31%, Ca blockers in 29% and beta blockers in 22% of all individuals with HF. The prevalence of particular groups of drugs administered in both genders was similar with the exception for calcium blockers, which were more frequently used in women (p<0.001), whereas long acting nitrates in men (p<0.001). In general, angiotensin converting enzyme inhibitors, long acting nitrates and cardiac glycosides use increased with age. On the contrary, beta blockers and calcium blockers were given mostly to younger patients. The most sick patients were more likely to receive angiotensin converting enzyme inhibitors, cardiac glycosides, long acting nitrates and diuretics, whereas less frequently beta blockers and calcium blockers. Combination therapy was used relatively rarely, with lowest percentage in NYHA IV. Conclusion: Compared to the other population studies, both angiotensin converting enzyme inhibitors and beta blockers were used relatively more frequently, although in the absolute terms the latter was clearly underused. The high rate of Ca blockers prescription is a matter of concern. More attention should be paid to optimising combination usage and introducing beta blockers early in all stable patients.