Outpatient management of heart failure in the United States, 2006-2008

Abstract

Better outpatient management of heart failure might improve outcomes and reduce the number of rehospitalizations. This study describes recent outpatient heart-failure management in the United States. We analyzed data from the National Ambulatory Medical Care Survey of 2006-2008, a multistage random sampling of non-Federal physician offices and hospital outpatient departments. Annually, 1.7% of all outpatient visits were for heart failure (51% females and 77% non-Hispanic whites; mean age, 73 ± 0.5 yr). Typical comorbidities were hypertension (62%), hyperlipidemia (36%), diabetes mellitus (35%), and ischemic heart disease (29%). Body weight and blood pressure were recorded in about 80% of visits, and health education was given in about 40%. The percentage of patients taking β-blockers was 38%; the percentage taking angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) was 32%. Medication usage did not differ significantly by race or sex. In multivariate-adjusted logistic regression models, a visit to a cardiologist, hypertension, heart failure as a primary reason for the visit, and a visit duration longer than 15 minutes were positively associated with ACEI/ARB use; and a visit to a cardiologist, heart failure as a primary reason for the visit, the presence of ischemic heart disease, and visit duration longer than 15 minutes were positively associated with β-blocker use. Chronic obstructive pulmonary disease was negatively associated with β-blocker use. Approximately 1% of heart-failure visits resulted in hospitalization. In outpatient heart-failure management, gaps that might warrant attention include suboptimal health education and low usage rates of medications, specifically ACEI/ARBs and β-blockers.

Keywords: Ambulatory care/standards; cardiovascular agents/therapeutic use; clinical trials as topic; comprehensive health care; drug utilization/statistics & numerical data; health care surveys; heart failure/drug therapy/economics/epidemiology/prevention & control; office visits/statistics & numerical data/trends/utilization; outcome assessment (health care)/trends; quality assurance, health care.

Fig. 1.

Use of some medications among heart-failure patients: National Ambulatory Medical Care Survey, 2006–2008. N=1,555; weighted n=16 million visits/yr. Graphs show visits based on whether A) heart failure was or was not the primary reason for the visit, B) examination was by a cardiologist or non-cardiologist, C) patients did or did not have hypertension, and D) patients did or did not have ischemic heart disease. ACEI/ARB = angiotensin-converting enzyme inhibitors/angiotensin receptor blockers; BB = β-blockers; CCB = calcium channel blockers; HF = heart failure; IHD = ischemic heart disease *P<0.05 was considered statistically significant.

Fig. 2.

Use of some medications among heart-failure patients: National Ambulatory Medical Care Survey, 2006–2008. N=1,555; weighted n=16 million visits/yr. Graphs show visits by A) sex, B) black patients versus others, C) patients with and without diabetes mellitus, D) patients with and without chronic renal insufficiency, and E) patients with and without chronic obstructive pulmonary disease or asthma. ACEI/ARB = angiotensin-converting enzyme inhibitors/angiotensin receptor blockers; BB = β-blockers; CCB = calcium channel blockers; COPD = chronic obstructive pulmonary disease; CRI = chronic renal insufficiency *P <0.05 was considered statistically significant

Fig. 2.

Continued