Influence of age and in-patient care on prescription rate and long-term outcome in chronic heart failure: a data-based substudy of the EuroHeart Failure Survey

Aims: To evaluate the prescription rate of neurohumoral drugs in chronic heart failure patients and the factors influencing prescription rates. Outcomes and their predisposing factors were also investigated. Methods and results: Of 1482 consecutive patients admitted to 3 Austrian hospitals participating in the EuroHeart Failure Survey, 341 were included in this data-based substudy. Follow-up time to evaluate outcome was up to 46 months. The prescription rates of renin– angiotensin (RAAS) antagonists and h-blockers at the time of discharge were evaluated. The overall prescription rate and dosage were lower than the recommended levels. Hospitals with cardiac care had a significantly higher prescription rate than those without (pb0.001). Patients older than 75 years received significantly less therapy (pb0.001) and a lower dosage of RAAS antagonists (pb0.01) than younger patients. Younger patients were treated more intensively in hospitals with cardiac care (pb0.05). Patients aged N75 years were under-treated, independent of the hospital (n.s.). Multivariate analysis showed that age was the most influencing factor on survival (v 2 15.5, pb0.0001). Additional influencing factors of long-term survival were type of the ward (v 2 7.9, pb0.005) and pharmacologic treatment (v 2 6.2, pb0.02). Conclusion: Patients with chronic heart failure are still under-treated in clinical practice. Younger patients benefit from hospitals with specialized cardiac care. Elderly patients are obviously under-treated compared with younger patients. Of several clinical parameters, age was the only independent variable predicting long-term survival.