Abstract 20676: Are Current Medication Recommendations being Implemented in Rural Heart Failure Patients with Impaired Ejection Fraction?
Background: Current medication recommendations for patients with reduced ejection fraction (EF) and symptoms of heart failure (HF) include (1) diuretic (if fluid overload present), (2) ACE-inhibitor (ACEI) or angiotensin receptor blocker (ARB), and (3) beta blocker. Adherence to these guidelines varies by demography. Little is known about HF care in rural patients. Baseline data from the REMOTE-HF randomized trial of fluid management education in rural HF patients in 3 states were analyzed to address this knowledge gap.
Methods: 304 patients who had been hospitalized for HF within the last year with an EF of < 40% were included. Median age was 64±13 years, 68% male, 86% white, 83% cared for by a cardiologist, and 91% with NYHA Class II or III. Chi square analysis was used to determine differences by EF and NYHA. Multivariate logistic regression was used to assess if demographic and clinical factors were associated with being prescribed individual medications as well as all three.
Results: are shown in the Table: * p < .01 ^p < .05 Logistic regression showed older patients were less likely (OR per year = .965; CI .987-.995) and those with NYHA III or IV more likely (OR = 2.15; CI 1.253–3.689) to be prescribed all three medications. Prescription for all three medications did not vary significantly by geographic location, gender, history of CHD, presence of hypertension, or treatment by a cardiologist.
Conclusions: Overall, fewer than two-thirds of patients were prescribed all three recommended medications for HF with reduced EF. Clinicians prescribe differently for older patients and in those with less symptomatic HF, both of whom may benefit from all three recommended medications.
- © 2010 by American Heart Association, Inc.