Trends and inequities in beta-blocker prescribing for heart failure
Trends and inequities in beta-blocker prescribing for heart failure
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DOI：
10.3399/bjgp08x376195
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发表时间：
2008-12-01
影响因子：
5.9
通讯作者：
Cook, Derek G.
中科院分区：
文献类型：
--
作者：
Shah, Sunil M.;Carey, Iain M.;Cook, Derek G.
背景：特异性受体阻滞剂治疗可降低心力衰竭的死亡率和住院率。目的描述-受体阻滞剂处方治疗心力衰竭的趋势和不公平。研究设计：对具有全国代表性的初级保健数据库（DIN-LINK）进行重复横断面分析。英国共有152个全科医生。方法对2000年至2005年期间平均每年7294例年龄在bb0 = 50岁的积极治疗心力衰竭的患者进行-受体阻滞剂处方的研究。心力衰竭定义为记录的心力衰竭诊断和两种处方血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂。主要结果是本年度指南推荐的-受体阻滞剂（比索洛尔、卡维地洛、美托洛尔或奈比洛尔）的处方。使用逻辑回归分析β受体阻滞剂处方的决定因素。结果2000年至2005年间，经年龄调整后推荐的β受体阻滞剂的使用在男性中从6.1%上升到27.0%，在女性中从4.2%上升到21.5%。2005年，年轻患者更有可能接受治疗；60-64岁患者与85岁患者的完全校正优势比为4.83（95%可信区间= 3.78 ~ 6.17）。生活在社会经济贫困地区的妇女和患者接受治疗的可能性较小。2005年，除了使用指南推荐的-受体阻滞剂治疗外，还有11.7%的男性和12.5%的女性服用了其他-受体阻滞剂。结论-受体阻滞剂的推荐使用量在英国有所上升，但仍然很低且不公平，许多患者仍然使用指南中未推荐的-受体阻滞剂进行治疗。这表明在处方方面仍有进一步改进的可能。
BackgroundTreatment with specific beta-blockers reduces mortality and hospitalisation in heart failure.AimTo describe trends and inequities in beta-blocker prescribing for heart failure.Design of studyRepeated cross-sectional analysis of a nationally representative primary care database (DIN-LINK).SettingA total of 152 UK general practices.MethodPrescribing of beta-blockers between 2000 and 2005 was examined among a yearly average of 7294 patients aged >= 50 years who had actively managed heart failure - defined as a recorded diagnosis of heart failure and two prescriptions of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker during the calendar year. The main outcome was the prescription of a guideline-recommended beta-blocker (bisoprolol, carvedilol, metoprolol, or nebivolol) in the year. Determinants of beta-blocker prescribing were analysed using logistic regression.ResultsBetween 2000 and 2005, age-adjusted use of recommended beta-blockers rose from 6.1% to 27.0% in men, and from 4.2% to 21.5% in women. In 2005, younger patients were more likely to be treated; the fully adjusted odds ratio was 4.83 (95% confidence interval = 3.78 to 6.17) for patients aged 60-64 years compared with those aged 85 years. Women and patients living in areas of socioeconomic deprivation were less likely to be treated. In 2005, in addition to treatment with guideline-recommended beta-blockers, a further 11.7% of men and 12.5% of women were prescribed other beta-blockers.ConclusionRecommended beta-blocker use has risen in the UK but remains low and inequitable, with many patients still treated with beta-blockers that are not recommended in guidelines. This suggests further improvements in prescribing are still possible.