Incremental effects of concurrent pharmacotherapeutic regimens for heart failure on hospitalizations and costs

Grant H. Skrepnek, Jacob Abarca, Daniel C. Malone, Edward P. Armstrong, Farshad M. Shirazi, Raymond L. Woosley

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


BACKGROUND: Inappropriate medication use in patients with heart failure (HF) presents challenges in providing optimal, evidence-based care. OBJECTIVE: To evaluate the incremental differences of concurrent and persistent use of angiotensin-converting enzyme (ACE) inhibitors, β-blockers, loop diuretics, and digoxin on the one-year, all-cause risk of hospitalization and total healthcare costs associated with treatment of HF in patients enrolled in a managed care organization within the US. METHODS: A retrospective database analysis was conducted spanning from January 1, 1997, to December 31, 1999. Multivariate regression methods were used to examine the association between treatment regimens and hospitalizations or costs after controlling for patient demographics and risk factors. RESULTS: Of the 1903 patients meeting inclusion criteria, 32.3% (n = 615) received none of the 4 HF agents studied and were associated with a 2.5 times greater risk (p ≤ 0.001) of hospitalization and 43.6% higher (p ≤ 0.001) total costs compared with all other patients with HF Comparatively, 13.9% (n = 264) utilized the HF medications investigated for at least 6 months. Of those with persistent use of ≥3 agents, approximate decreases in hospitalizations were noted of 80% (p ≤ 0.001) and total costs of 70% (p ≤ 0.001) relative to patients receiving no HF therapy. CONCLUSIONS: A substantial portion of patients with HF may be receiving suboptimal pharmacotherapeutic care in real-world practice settings, potentially incurring large increases in hospitalizations and total costs. Quality improvement initiatives should seek to identify and manage those not being treated according to guideline recommendations.

Original languageEnglish (US)
Pages (from-to)1785-1791
Number of pages7
JournalAnnals of Pharmacotherapy
Issue number11
StatePublished - Nov 2005


  • Costs
  • Digoxin
  • Heart failure; angiotensin-converting enzyme inhibitors
  • Loop diuretics
  • β-blockers

ASJC Scopus subject areas

  • Pharmacology (medical)


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