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Pharmacological Treatment of Chronic Heart Failure: A Population based Study in a Heart Failure Clinic
Linnaeus University, Faculty of Science and Engineering, School of Natural Sciences.
2011 (English)Independent thesis Advanced level (degree of Master (One Year)), 20 credits / 30 HE creditsStudent thesis
Abstract [en]

Background: Heart failure is a disease that appears with systolic and/or diastolic dysfunction mainlyof the left ventricle. In systolic dysfunction, the decline in pumping capacity activates compensatorymechanisms largely through activation of the adrenergic and the renin-angiotensin-aldosteronesystems in order to increase the cardiac output. Chronic activation of these systems has long-termadverse consequences. Their actions are therefore blocked pharmacologically by ACE-inhibitors(ACEIs), angiotensin receptor blockers (ARBs), aldosterone receptor antagonists and beta-blockers.Aim of the study: To find out how a population of patients with chronic heart failure were treatedconcerning ACEIs/ARBs and beta-blockers, the tolerability of this treatment, if they were givendiuretics and the aldosterone antagonist spironolactone and if the treatment improved their condition.

Material and methods: The study was performed on 84 patients with chronic heart failure visiting aHeart failure clinic from the first of July in 2000 until the end of June in 2001. The patients wereobserved during one year after the first visit or until they died.

Results: ACEIs/ARBs were given to 80/84 patients (95.2%). Target doses were reached by 67/84patients (79.8%). One year after the visit, ACEI/ARB treatment was known to be present in 61/84(72.6%), absent in 12 and unknown in 11 patients. Increased levels of creatinin and/or potassium werethe most common reasons for decreasing the dose or interrupting the treatment (9 patients) and 6 patients had a change from an ACEI to an ARB because of cough. Beta-blockers were given to 71/84patients (84.5%). Target doses were reached by 20/84 patients (23.8%), less than the number ofpatients on target doses of ACEIs/ARBs (p<0.001). One year after the visit, beta-blockade treatmentwas known to be present in 57/84 (67.9%), absent in 13 and unknown in 14 patients. Breathlessness/exacerbation of heart failure was the most common reason for interrupting thetreatment or decreasing the dose (5 patients) followed by hypotension (4 patients). Diuretic treatment,except spironolactone, present in 67/84 patients at the time of the visit was stopped in 8 patients andspironolactone was known to be given to 31/84 patients. The heart failure condition one year after thevisit was considered to be better in 20 patients (23.8%), unchanged in 21 (25.0%), worse in 5 (6.0%),uncertain in 29 (34.5%) and 9 patients died. Hospital admissions decreased from 81.0% during theyear before the visit to 39.3% during the year after (p<0.001).

Conclusion: More patients reached target doses of ACEIs/ARBs than of beta-blockers (p<0.001).Hospital admissions decreased from 81.0% before the visit to 39.3% after the visit (p<0.001).

Place, publisher, year, edition, pages
2011. , p. 68
Keywords [en]
heart failure, ACE-inhibitors, angiotensin receptor blockers, beta-blockers
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:lnu:diva-12674OAI: oai:DiVA.org:lnu-12674DiVA, id: diva2:424111
Subject / course
Biomedicine
Uppsok
Medicine
Supervisors
Examiners
Available from: 2011-06-17 Created: 2011-06-17 Last updated: 2011-06-17Bibliographically approved

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