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

Aims: 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, 9,547 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 beta-blockers (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. 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.