Evolution of the Therapeutic Profile over a Three Year- Period in Heart Failure Patients

Abstract

Background: Recent studies have shown that recommended drugs for the treatment of chronic heart failure (CHF) are under-prescribed in daily practice. This gap between guidelines and clinical practice is even more pronounced in developing countries, including Romania. Aim: To compare the characteristics and the modality of treatment of patients with CHF discharged from a General Romanian Hospital in 2009, with those of an analogous patient population observed three years earlier, in 2006. Methods: There were studied two cohorts of patients (from 2006-415 patients, 67.08±10.59 years old vs from 2009-500 patients, aged 67.31±11.27 years) admitted in the Rehabilitation Hospital-Cardiology Department with a diagnosis of CHF class NYHA II-IV. The mean LVEF was 56.09±14.83% in 2006 and 58.91±15.41% in 2009. In all patients recommended drug therapy was compared with the recommendations made by the ESC 2005 and 2008 guidelines, respectively. Results: Inhibitors of the Renin-Angiotensin System were prescribed to the great majority of patients, the percentage being 74.4% in 2006 vs 77.20 % in 2009. A decrease of ACEI (71.3% vs 65.2%; p<0.01) and an important increase of ARB's use (3.1% vs 12.20% p<0.01) were registered. Beta-blockers use increased (51.8% vs 69.2%), prescription of loop diuretics and aldosterone antagonists' slightly decreased (89.4% vs 85%, 80.2% vs 67.8%). Digoxin was less used in 2009 (57.10% vs 42.60 %) even though the percentage of patients with atrial fibrillation was no different between the two years. The use of antiplatelet drugs increased (32.23% vs 56.5 %). Conclusions: There was an improvement in guidelines adherence over a three-year period in Romania. Renin- angiotensin inhibitors, beta-blockers and diuretics are used according to the guidelines recommendations, yet antiplatelets remain underused.