Copyright © 1999 by the European Society of Cardiology.
Differences in drug treatment of chronic heart failure between European countries
a Department of Cardiology/Thoraxcentre, University Hospital Groningen, Groningen
b Academic Medical Centre, Amsterdam, The Netherlands
c Nottingham Clinical Trial Data Centre, Queen’s Medical Centre, University Hospital, Nottingham, U.K.
d Cardiovascular Medicine, Queen’s Medical Centre, University Hospital, Nottingham, U.K.
revised September 22, 1998; accepted September 30, 1998
Abstract
Aims
A large number of drugs are currently used for the treatment of chronic heart failure. Treatment for other cardiovascular disorders has been shown to differ between countries. In this study we examined whether this would also be true in heart failure.
Methods and Results
We studied patients with moderate to severe heart failure, who were enrolled in an international survival study, and compared patterns of drug use between the nine countries that each included >50 patients in the study. The results were analysed to determine whether observed differences between countries could be explained by differences in the patients recruited. 1825 patients were studied (range 81–427 per country). By trial protocol, most patients were treated with angiotensin converting enzyme (ACE) inhibitors (92%) and all with diuretics, but the proportion of patients taking high doses of these drugs was markedly different between countries. Large differences were also observed in the use of digoxin (overall 64%, 39% in the U.K. to 87% in Germany) and antiarrhythmics (overall 25%, with the highest use 44% in France). The use of beta-blockers and calcium antagonists was low (overall 6% and 8%, respectively), but also different between countries. Anticoagulants (overall 43%) were used in many patients in the Netherlands and Switzerland (around 70%), while antiplatelets (overall use 30%) were most often prescribed in Denmark (51%).
Conclusions
Large differences in drug use and dosing for patients with advanced heart failure are observed between (European) countries. None of these differences could be explained by differences in patient characteristics, and whether they are related to factors such as tradition, economic circumstances and national guidelines, etc. is unknown.
Key Words: Heart failure • treatment • international differences
f1 Dr van Veldhuisen is a Clinical Scientific Investigator of the Dutch Heart Foundation.
f2 Correspondence: Dr Dirk J. van Veldhuisen, Department of Cardiology/Thoraxcentre, University Hospital Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands.
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