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Author List:
Johnson ML (Houston HSRD)
Henderson LM (Houston HSRD)
Petersen NJ (Houston HSRD)
Espadas D (Houston HSRD)
Yu HJ (Houston HSRD)
Campbell JA (Houston HSRD)
Moffett M (Houston HSRD)
Deswal A (Houston HSRD)
Objectives:
To examine patterns of use of drugs for the treatment of chronic heart failure (CHF) and how these patterns change over time.
Methods:
We identified a national cohort of patients with CHF from the outpatient clinic files (OPC) beginning in fiscal year 1997 (FY97) and obtained their outpatient pharmacy prescription fill records from the Pharmacy Benefits Management Strategic Healthcare Group (PBM) for FY99 through FY02. We created categories of drugs for the treatment of CHF using the drug class and product information, and tabulated the proportion of patients receiving filled prescriptions for each category. To adjust for severity of illness and to distinguish birth cohort effects from real changes in practice patterns, patients were stratified based on number of years in the cohort. We then compared patterns of use between groups over time.
Results:
The total number of patients ranged from 222,679 in FY99 to 301,777 in FY02. The average age(sd) ranged from 69.7(10.3) to 71.1(10.4). The most prevalent categories in FY99 were ACE or angiotensin II inhibitors (65.6%), loop diuretics (64.3%), digitalis glycosides (40.4%), calcium channel blockers (37.1%), beta blockers (37.1%) and statins (36.4%). By FY02, digitalis and calcium channel blockers decreased to 33.6% and 32.1%, while beta blockers and statins increased to 53.5% and 51.3%, respectively. ACE or angiotensin II inhibitor and loop diuretic use remained relatively constant (68.5% and 61.7%, respectively). In FY99, 40.6% of newly identified patients received beta blockers, whereas 58.9% of newly identified patients in FY02 were started on beta blockers. Of those first-year survivors from FY99, beta blocker use increased to 52.7%, indicating that 29.8% of surviving patients were added to beta blockers and/or survived longer than patients who were not started on that drug class. Similar patterns were confirmed within the other cohort subgroups.
Implications:
Patterns of care for patients with CHF changed, which could not be explained by birth cohort effects alone, indicating that there were true changes in pharmacotherapeutic practice. Future work will link these changes in process of care patterns to survival, utilization and cost.
Impacts:
Pharmacotherapy patterns changed for patients with CHF from 1999 to 2002, as new evidence emerged from clinical trials.
