Drug therapy in heart failure : studies on prescribing, drug induced problems and compliance

Abstract

Due to the ageing of the population and increased survival of patients with acute coronary artery disease, an ‘epidemic’ of heart failure is emerging, illustrated by increasing rates of hospitalisations for heart failure and resulting in a considerable increase in the cost of care for these patients. In the past decades new insights in the pathophysiology of heart failure and evidence of the benefits of several categories of drugs have made treatment of heart failure more rewarding. Treatment, however, has also become more complex. Patients with heart failure are in general over 70 years old and have a history of ischaemic heart disease and multiple comorbidities. Treatment of both heart failure and these comorbidities leads to the use of a broad range of very powerful medicines. The inappropriate use of these medicines can have a major impact on outcomes of pharmacotherapy. This thesis gives an overview of changes in the drug treatment of heart failure between 1990 and 1998 and addresses a range of drug related problems in patients with chronic heart disease. Topics addressed are patient non-compliance, early discontinuation of drugs, underutilisation of drugs with proven benefits, adverse drug reactions and interactions. Several suggestions to improve management and pharmacotherapy in heart failure, both for prescribers and pharmacists, are provided.