Prescribing trends for management of congestive heart failure from 2002 to 2004

National surveys to evaluate prescribing practices: Methodological considerations

With the changing healthcare landscape, evaluating the care provision in ambulatory settings is vital to understand outpatient care. The national surveys such as the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) are valuable resources to pharmacy researchers because of their availability and generalizability. With the recent focus on real-world data, the national surveys are critical in providing practice and policy evidence by evaluating ambulatory care, especially prescribing practices. The use of these surveys requires an understanding of the survey content, scope, complex sampling scheme, and analytical and research considerations. There are several methodological and practical considerations that make these national surveys useful to both novice and seasoned researchers. Although some generalized approaches are available for analyzing the national surveys, there is limited focus on the NAMCS and the NHAMCS. This paper provides an in-depth understanding of the NAMCS/NHAMCS, including methodological considerations for evaluating prescribing practices in ambulatory settings.

Treatment of heart failure in nursing home residents

Background

For the treatment of chronic heart failure (HF), both pharmacological and non-pharmacological treatment should be employed in HF patients. Although HF is highly prevalent in nursing home residents, it is not clear whether the recommendations in the guidelines for pharmacological therapy also are followed in nursing home residents. The aim of this study is to investigate how HF is treated in nursing home residents and to determine to what extent the current treatment corresponds to the guidelines.

Methods

Nursing home residents of five large nursing home care organizations in the southern part of the Netherlands with a previous diagnosis of HF based on medical records irrespective of the left ventricle ejection fraction (LVEF) were included in this cross-sectional design study. Data were gathered on the (medical) records, which included clinical characteristics and pharmacological- and non-pharmacological treatment. Echocardiography was used as part of the study to determine the LVEF.

Results

Out of 501 residents, 112 had a diagnosis of HF at inclusion. One-third of them received an ACE-inhibitor and 40% used a β-blocker. In 66%, there was a prescription of diuretics with a preference of a loop diuretic. Focusing on the residents with a LVEF ≤ 40%, only 46% of the 22 residents used an ACE-inhibitor and 64% a β-blocker. The median daily doses of prescribed medication were lower than those that were recommended by the guidelines. Non-pharmacological interventions were recorded in almost none of the residents with HF.

Conclusions

The recommended medical therapy of HF was often not prescribed; if prescribed, the dosage was usually far below what was recommended. In addition, non-pharmacological interventions were mostly not used at all.