The relevance of comorbidities for heart failure treatment in primary care: A European survey

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Abstract
1 Aim: To assess the impact of comorbidities on chronic heart failure (CHF) therapy. 2 Methods: The IMPROVEMENT‐HF survey included 11,062 patients from 100 primary care practices in 14 European countries. The influence of patient characteristics on drug regimes was assessed with multinomial logistical regression. 3 Results: Combined drug regimes were given to 48% of CHF patients, consisting of 2.2 drugs on average. Patient characteristics accounted for 35%, 42% and 10% of the variance in one‐, two‐ and three‐drug regimes, respectively. Myocardial infarction (MI), atrial fibrillation (AF), diabetes, hypertension, and lung disease influenced prescribing most. AF made all combinations containing β‐blockers more likely. Thus for single drug regimes, MI increased the likelihood for non‐recommended β‐blocker monotherapy (OR 1.3; 95% CI 1.2–1.4), while for combination therapy recommended regimes were most likely. For both hypertension and diabetes, ACE‐inhibitors were the most likely single drug, while the most likely second drugs were β‐blockers in hypertension and digoxin in diabetes. 4 Conclusions: Patient characteristics have a clear impact on prescribing in European primary care. Up to 56% of drug regimes were rational taking patient characteristics into account. Situations of insufficient prescribing, such as patients post MI, need to be addressed specifically.