Disparity of physician specialties in the management of chronic heart failure: trend analysis in Taiwan, 2000 - 2010.

Abstract

OBJECTIVE:

Chronic heart failure (CHF) is a condition that is daily confronted by clinicians in a variety of medical specialties, where physicians routinely seek optimum pharmacotherapy for their outpatients with CHF. We conducted a population- based study on pharmacotherapy for outpatients with CHF in Taiwan from 2000 to 2010, which focused on drug prescription patterns of different physician specialties.

MATERIALS AND METHODS:

We retrieved records from the National Health Insurance Research Database of patient ambulatory visits with diagnosed chronic heart failure, when cardiovascular drugs were prescribed. For purposes of this study, anti-chronic heart failure drugs were separated into categories: mortality reducing agents (angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, spironolactone, hydralazine plus nitrates) and symptom-relieving agents (digoxin, diuretics). Thereafter, the trends of prescription patterns related to different physician specialties were analyzed.

RESULTS:

From 2000 to 2010, the prescription rate of any mortality-reducing agent for CHF outpatients rose from 61.5% to 76.3% while the concomitant rate for digoxin decreased from 47.3% to 45.4%. Compared to internists and family physicians, cardiologists not only prescribed far more mortality-reducing agents from 2000 to 2010 (53.9 - 72.7%, 54.1 - 64.3%, 74.7 - 84.4%, respectively), but also prescribed two or three mortality-reducing drugs.

CONCLUSION:

There was a significant improvement of optimal pharmacotherapy for chronic heart failure in Taiwan. We observed that cardiologists were more aggressive than non-cardiologists when deciding whether to prescribe mortality-reducing drugs for heart failure management. However, those factors which influence the prescription patterns of internists and family physicians for their patients with CHF still require additional research.

• Authors: Chia-Yu Chou, Tzeng-Ji Chen, Shu-Chiung Chiang, Yu-Chun Chen, Ming-Hui Cheng, Yao-Chia Yang, Cheng-Hsueh Wu, Chin-Chin Ho, Yu-Ju Huang, Yueh-Ching Chou
• Journal: International journal of clinical pharmacology and therapeutics (Int J Clin Pharmacol Ther) Vol. 51 Issue 8 Pg. 678-87 (Aug 2013) ISSN: 0946-1965 [Print] Germany
• PMID: 23849437 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Angiotensin Receptor Antagonists
• Angiotensin-Converting Enzyme Inhibitors
• Digoxin

Topics

• Aged
• Aged, 80 and over
• Angiotensin Receptor Antagonists (therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Digoxin (therapeutic use)
• Female
• Heart Failure (drug therapy)
• Humans
• Male
• Practice Patterns, Physicians'
• Specialization
• Taiwan
• Time Factors