Use of Guideline-Recommended Therapies for Heart Failure in the Medicare Population

Abstract

Background

Most information about the use of guideline-recommended therapies for heart failure reflects what occurred at discharge after an inpatient stay.

Hypothesis

Using a nationally representative, community-dwelling sample of elderly Medicare beneficiaries, we examined how the use of angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and β-blockers has changed and factors associated with their use.

Methods

Using data from the Medicare Current Beneficiary Survey cost and use files matched with Medicare claims data, we identified beneficiaries for whom a diagnosis of heart failure was reported between January 1, 2000, and December 31, 2004. Data on medications prescribed during the year of cohort entry were based on patient self-report. We used multivariable logistic regression to explore relationships between the use of ACE inhibitors/ARBs and β-blockers and patient demographic characteristics.

Results

From 2000 through 2004, the use of ARBs increased from 12% to 19%, and the use of β-blockers increased from 30% to 41%. The use of ACE inhibitors remained constant at 45%. Beneficiaries who reported having prescription drug insurance coverage were 32% more likely than other beneficiaries to have filled a prescription for an ACE inhibitor or ARB and 26% more likely to have filled a prescription for a β-blocker.

Conclusions

Although the use of guideline-recommended therapies for heart failure has increased, it remains suboptimal. Copyright © 2010 Wiley Periodicals, Inc.