The Association of Guideline Recommended Medications and Health-Related Quality of Life in Patients with Heart Failure.



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OBJECTIVES: This study was aimed at understanding the association of guideline recommended medications and health related quality of life in heart failure patients and predictors of guideline recommended medication utilization. METHODS: A cross sectional as well as longitudinal analysis was conducted on a cohort of patients diagnosed with heart failure from years 2002 to 2009 identified from panels 7 to 13 of Medical Expenditure Panels Survey (MEPS) data files respectively. Anderson behavior model was used where predisposing factors, enabling factors and need factors that influenced medication utilization were determined. Here binary variables indicating use of medication (yes/no) for each medication was our dependent variable and logistic regression models were conducted to determine predictors of medication use. Two multiple linear regression models were used with PCS and MCS scores from round 4 as dependent variables while controlling for baseline PCS and MCS scores to assess the effect of medications on Health Related Quality of Life (HRQoL). PROC SURVEYLOGISTIC and PROC SURVEYREG procedures were used in SAS with significance level of 0.05. RESULTS: Among 10.7 million individuals identified as heart failure patients, only 62% received ACE/ARBs, 58% received beta-blockers, 76% received diuretics and about 9% patients received aldosterone receptor antagonists. ACEI/ARB and beta blockers did not show any improvement in HRQoL of heart failure individuals while with unit increase in ARA use, the PCS score decreases by 2.809 (CI: -5.15 – 0.47; P-value: 0.0186) units and with unit increase in diuretics use the score increases by 3.3 units (CI: 1.57-5.03; P-value: 0.0002). Also factors like IADL limitations and CCI were associated with prescription of ACEI/ARB and beta-blockers. Factors like age, general health status, IADL limitations and Charlson Comorbidity Index were found to be significant predictors of ACEI/ARB and beta blocker medication utilization. CONCLUSION: Utilization of medications such as ACEI/ARBs and beta-blockers did not have an effect on HRQoL. For any chronic patient, quality of life can be correlated to medication use as well as non pharmacologic treatments. Our findings explain low utilization of these medications which may also be influenced by patient’s current severity of condition.



Heart failure, Congestive heart failure, ACC/AHA, ACEI, ARB, Beta-blockers, Quality of life, Health sciences, HRQoL, Cardiovascular