Heart failure the epidemic in the rural area: characteristics and management in a rural health center of Albacete
DOI:
https://doi.org/10.19230/jonnpr.3637Keywords:
Heart failure, Diagnosis, Treatment, Readmissions, Morbidity, MortalityAbstract
Introduction and objective. Proper management in chronic heart failure (CHF) patients reduces their morbidity as well as the mortality and therefore the number of hospital readmissions. Numerous studies report about their management in the hospital setting, while in primary care they are scarce. The objective is to evaluate the application of European Society of Cardiology clinical guidelines in the chronic heart failure patients in primary care setting.
Methods. Observational descriptive design focusing on management, use of medications and indication- prescription. Population and sample: Primary care teams in the area of Casas Ibañez (Albacete). The study population consists of patients with chronic heart failure diagnosis classes from II to V according to the New York Heart Association (NYHA). Data were collected from a registry of 224 patients with chronic heart failure belonging to 10 primary care physicians. All patients diagnosed with Chronic Heart Failure (223 patients) belonging to the rural strata were selected. Main measurements: adherence to the drugs recommended in the clinical guideline is evaluated using 2 indicators, one global and the other for drugs with a higher degree of evidence (A1: angiotensin converting enzyme inhibitors / angiotensin II receptor blockers [ACE Inhibitors/ ARBs], ?-blockers [BB] and spironolactone).
Results. 223 patients are studied, with an average age of 78.4 years, of which 53.1% are women. Arterial hipertension (AHT) and cardiac ischemia cause 64.7%. The average comorbidity, excluding CHF, was 2.9. 40.4% were class III-IV of the NYHA. The Global Adherence Index (diuretics, ACE Inhibitors / ARBs, ?-blockers, spironolactone, digoxin and oral anticoagulants) and the Adherence to Evidence A1 (ACE Inhibitors / ARBs, ?- blockers and spironolactone) were 55.2 and of 44.6% respectively. Only 12.9% of patients showed perfect adherence to medications with the higher degree of evidence while 39.5% had low adherence. Having less than 70 years, the history of ischemic heart diseases, AHT and hospital admissions are variables associated with better adhesion.
Conclusion. There is an underutilization of medications recommended by the clinical guideline for congestive heart failure management, especially those with better evidence to reduce morbidity and mortality.
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