P-137: Hypertensive heart failure patients: Pharmacologic treatment patterns by primary care physicians in va and non-va settings

Abstract

Hypertensive Heart Failure Patients: Pharmacologic Treatment Patterns by Primary Care Physicians in VA and non-VA Settings. Brent M. Egan, Michael R. Zile, Jan N. Basile, Florence N. Hutchison. Department of Medicine, Veterans Affairs (VA) Hospital & Medical University of South Carolina, Charleston, South Carolina.

Hypertension (HT) is a common antecedent of heart failure (HF) and many patients remain hypertensive after developing HF. Several antihypertensive medications have proven benefits in HF patients including ACEI, angiotensin receptor blockers (ARB), aldosterone antagonists (AA), and (α)β-blockers. We reviewed our primary care database of 70,264 HT patients and identified 5703 with a clinical diagnosis of HF (8%). Findings are summarized in the Table for all HT and all HF patients and for HF patients treated at VA and non-(n)VA primary care clinics. HT patients with HF are older and more likely to have hyperlipidemia and diabetes than all HT, and they are more likely to receive ACEI, AA, and (α)β-blockers (all p<0.001). The greater use of these meds as well as loop diuretics, spirinolactone, and CCBs (all p<0.001) may contribute to higher rates of BP control in HF than non-HF patients, despite their advanced age. HF patients at the VA were more likely to receive ACEI and less likely to receive ARBs than nVA HF patients (p<0.001), which likely reflects formulary restrictions. HF patients at the VA were also more likely to receive (α)β-blockers and statins than nVA HF patients (p<0.001), which may reflect differences in prescribing patterns and/or better access to these medications at the VA. Primary care providers are more aggressive in treating HT and comorbid risk factors in patients with than without HF. There are several similarities but also striking differences between treatment of HT patients with HF at VA and nVA settings that could favor better outcomes (more [α]β-blockers, statins, better LDL, HbA1c) for HF patients at the VA.

	All (70.264)	All HF (5703)	VA HF (3010)	nVA HF (2693)
Men:Women	60:40	71:29	99:1	39:61
White:Black:Unknown	42:31:25	45:31:23	59:30:11	30:33:36
Age, years	61.3	70.4	70.3	70.6
Blood pressure	138/79	134/73	132/71	137/75
<140/90, %	50%	58%	63%	53%
ACEI, %	45%	68%	74%	62%
ARB, %	12%	11%	1%	21%
Aldo antagonist, %	9%	19%	20%	18%
(α)β-blocker, %	33%	63%	77%	46%
Thiazide, %	44%	37%	37%	37%
Loop, %	14%	71%	78%	63%
Spironolactone (S), %	3%	16%	18%	14%
CCB, %	39%	55%	58%	51%
Hyperlipidemia	54%	62%	71%	51%
‘Statin’	33%	48%	60%	35%
LDL <100 mg/dL	31%	40%	44%	35%
Diabetes (D)	31%	50%	53%	47%
HbA1c <7% in D	44%	44%	49%	39%

Hypertensive, Heart Failure, Pharmacologic Treatment Patterns