02971nas a2200373 4500008004100000022001400041245011900055210006900174260001300243300001000256490000800266520185400274653003202128653000902160653004402169653004502213653001902258653001702277653003002294653001102324653001802335653001102353653000902364653002602373653001502399100002302414700002102437700001902458700002202477700002402499700001902523700002002542856003502562 2004 eng d a1097-674400aTime trends in the use of beta-blockers and other pharmacotherapies in older adults with congestive heart failure.0 aTime trends in the use of betablockers and other pharmacotherapi c2004 Oct a710-70 v1483 a

BACKGROUND: Evidence supporting pharmacotherapy of congestive heart failure (CHF) has grown substantially over the past decade and includes large, placebo-controlled trials with mortality end points. We describe beta-blocker and other medication temporal treatment trends of CHF in the Cardiovascular Health Study, a community-based cohort study of 5888 adults > or =65 years of age.

METHODS: Prescription medication data were collected from hospital discharge summaries for incident CHF events and at in-study annual clinic visits for prevalent CHF cases from 1989 to 2000. Change in use of agents over time was estimated by using generalized estimating equations while adjusting for potential confounding factors of age, sex, race, and cardiovascular and pulmonary comorbidities.

RESULTS: Among 1033 incident CHF events, beta-blocker use after diagnosis increased an average of 2.4 percentage points annually (95% CI, 1.5 to 3.4 points) from 1989 to 2000. The increasing trend was consistent throughout follow-up. Among participants with coronary disease and/or hypertension and among those with low ejection fractions (<45%), beta-blocker use remained flat from 1989 to 1994 and increased 4.7 points annually (2.5 to 6.9) and 10.0 points annually (6.1 to 13.8), respectively, from 1995 to 2000. Among participants without coronary disease or hypertension, there was no overall increase in use. Use of renin-angiotensin system inhibitors increased 2.3 points annually (1.0 to 3.5), digoxin use decreased 2.4 points annually (-3.6 to -1.1), and loop diuretic use remained flat between 1989 and 2000. In general, treatment trends were similar for prevalent CHF.

CONCLUSIONS: Treatment of CHF has changed gradually in the 1990s and may in part reflect the influence of CHF clinical trial evidence.

10aAdrenergic beta-Antagonists10aAged10aAngiotensin II Type 1 Receptor Blockers10aAngiotensin-Converting Enzyme Inhibitors10aCohort Studies10aDrug Therapy10aDrug Therapy, Combination10aFemale10aHeart Failure10aHumans10aMale10aMultivariate Analysis10aPrevalence1 aSmith, Nicholas, L1 aChan, Jeannie, D1 aRea, Thomas, D1 aWiggins, Kerri, L1 aGottdiener, John, S1 aLumley, Thomas1 aPsaty, Bruce, M uhttps://chs-nhlbi.org/node/807