Time-trends in treatment and cardiovascular events in patients with heart failure: A pharmacosurveillance study

Purpose: Prognosis for patients with a first hospitalisation for heart failure (HF) may have improved, but data beyond 2003 are lacking. We assessed the temporal relationship of cardiovascular events and treatment in patients with a first hospitalisation for HF between 1998-2007. Methods: Data were obtained from the PHARMO Record Linkage System, a Dutch population-based registry of pharmacy records linked with hospital discharge records. Patients were selected based on a first hospital discharge of documented HF. Two time-periods were compared: 1998-2002 and 2003-2007. We analyzed all prescribed cardiovascular medication and the occurrence of events within the first year after hospitalisation for HF. Cardiovascular events were defined as rehospitalisation for HF, myocardial infarction or stroke; ischemic events as myocardial infarction or stroke. Logistic and cox regression analysis was performed to calculate odds ratios (OR), hazard ratios (HR), and 95% confidence intervals (CI) between the two time-periods. Results: We identified 17,921 patients (8374 between 1998-2002, 9547 between 2003-2007). Mean age was 75±11 and 76±11 years, respectively. There was an increase in almost all prescriptions in the second period, particularly betablockers (Table). In the first year after hospitalisation there was no clear reduction in the risk for any cardiovascular event between the two time-periods. The incidence of ischemic events was reduced in the second time-period compared to the first.(Table presented) Conclusion: This large study shows that prescription of cardiovascular medication in patients with a first hospitalisation for HF increased in recent years, while the incidence of ischemic events decreased.