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International variations in the treatment and co-morbidity of left ventricularsystolic dysfunction: data from the EuroHeart failure survey
Lainščak, Mitja ...
Background: Treatment of heart failure (HF) due to Ieft ventricular systolic dysfunction (LVSD) is effective, but many patients are not treated in accordance with guidelines. This may reflect a lack ...of adequate organisation of care or co-morbidity contra-indicating therapy. Aims: To evaluate the effect of co-morbidities on the prescription of neurohormonal antagonists for HF. Methods and results: The EuroHeart Failure Survey identified 10,701 paticncs with suspected or confirmed HF during 2000 and 2001, 64% of whom had an imaging test and 3658 had documented LVSD. This last group constiW tes the focus of this report. Renal dysfunction was associated with lower prescriptionof ACE inhibitors at discharge (74% vs. 83%, p < 0.001). Beta-blockers were less often used in patients with respiratory disease (32% vs. 53%, p<0.001). Co-morbidity did not appear to affect the use of spironolactone. There were few important international differences in uptake of key therapies amongst European countries with widely differing cultures andeconomic status. Conclusions: Guidelines appear successful creating a relatively uniform approach to the treatment for HF due to LVSD in diverse medical cultures. Relevant co-morbidity seems to be responsible for a substantial reduction in the prescription of ACE inhibitors and beta-blockers.However, whilst co-morbidity indicates the need for greater caution, it is often not a valid contra-indication to life-saving therapy.
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