Outpatient management of heart failure in the United States, 2006-2008

Kailash Mosalpuria, Sunil K. Agarwal, Sirin Yaemsiri, Bredy Pierre-Louis, Samir Saba, Rene Alvarez, Stuart D. Russell

Research output: Contribution to journalArticle

Abstract

Better outpatient management of heart failure might improve outcomes and reduce the number of rehospitalizations. This study describes recent outpatient heart-failure management in the United States. We analyzed data from the National Ambulatory Medical Care Survey of 2006-2008, a multistage random sampling of non-Federal physician offices and hospital outpatient departments. Annually, 1.7% of all outpatient visits were for heart failure (51% females and 77% non-Hispanic whites; mean age, 73 ± 0.5 yr). Typical comorbidities were hypertension (62%), hyperlipidemia (36%), diabetes mellitus (35%), and ischemic heart disease (29%). Body weight and blood pressure were recorded in about 80% of visits, and health education was given in about 40%. The percentage of patients taking β-blockers was 38%; the percentage taking angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARBs) was 32%. Medication usage did not differ significantly by race or sex. In multivariate-adjusted logistic regression models, a visit to a cardiologist, hypertension, heart failure as a primary reason for the visit, and a visit duration longer than 15 minutes were positively associated with ACEI/ARB use; and a visit to a cardiologist, heart failure as a primary reason for the visit, the presence of ischemic heart disease, and visit duration longer than 15 minutes were positively associated with β-blocker use. Chronic obstructive pulmonary disease was negatively associated with β-blocker use. Approximately 1% of heart-failure visits resulted in hospitalization. In outpatient heart-failure management, gaps that might warrant attention include suboptimal health education and low usage rates of medications, specifically ACEI/ARBs and β-blockers.

Original languageEnglish (US)
Pages (from-to)253-261
Number of pages9
JournalTexas Heart Institute Journal
Volume41
Issue number3
DOIs
StatePublished - Jun 2014

Keywords

  • Ambulatory care/standards
  • Cardiovascular agents/therapeutic use
  • Clinical trials as topic
  • Comprehensive health care
  • Drug utilization/statistics & Numerical data
  • Health care surveys
  • Heart failure/drug therapy/economics/epidemiology/prevention & control
  • Office visits/statistics & numerical data/trends/utilization
  • Outcome assessment (health care)/trends
  • Quality assurance, health care

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Mosalpuria, K., Agarwal, S. K., Yaemsiri, S., Pierre-Louis, B., Saba, S., Alvarez, R., & Russell, S. D. (2014). Outpatient management of heart failure in the United States, 2006-2008. Texas Heart Institute Journal, 41(3), 253-261. https://doi.org/10.14503/THIJ-12-2947