Drug utilization trends in patients seen in the Canadian chronic heart failure clinic network January 1999-June 2000.

Abstract:

Several important clinical trials were presented or published
in 1998/99 including RALES, CIBIS-2, MERIT-HF, BEST and HOPE. To
determine the early impact of these results on clinical practice
in the management of chronic heart failure (CHF), we analysed the
database of the Canadian CHF clinic network between January 1999
and June 2000. This longitudinal computerised database currently
represents practice across Canada in 11 referral centres with
specialised CHF clinics. The data presented is from the time of
first data entry into the database and includes both new patients
to the CHF clinic and patients previously seen in the CHF clinic.
Mean results on 1512 patients are reported; age 62.5 years, LVEF
29%, NYHA I 12%, II 39%, III 39%, IV 10%. Assessment of clinical
outcomes is being prospectively followed with the Network
database. The most marked changes were seen in the utilization of
spironolactone and ramipril demonstrating that some clinical
trials can have an immediate impact on practice patterns. Further
evaluation of the impact of specialised CHF clinics on drug
utilization and patient outcomes is warranted.

Drug Utilization by Quarter

 
1999
 
2000

 
1Q
2Q
3Q
4Q
 
1Q
2Q

Beta Blockers (%)
40
54
63
46
 
52
52

ACE-I's (%)
74
75
71
69
 
81
82

Ramipril as % ACE-I (%)
14
18
37
39
 
26
19

ARB's (%)
 8
 9
10
 9
 
10
9

Spironolactone (%)
 5
10
22
32
 
33
29

Furosemide (%)
73
84
77
69
 
80
81

Digoxin (%)
50
62
64
50
 
56
50