Prescription Bias in the Treatment of Chronic Systolic Heart Failure
Authors: Henrike Arfsten, Georg Goliasch, Noemi Pavo, Hanno Ulmer, Martin Hülsmann, Thomas Stefenelli
Journal: Annals of Internal Medicine (2019)

Letters7 January 2020Prescription Bias in the Treatment of Chronic Systolic Heart FailureHenrike Arfsten, MD, Georg Goliasch, MD, PhD, Noemi Pavo, MD, PhD, Hanno Ulmer, PhD, Martin Hülsmann, MD, and Thomas Stefenelli, MD, on behalf of the Austrian Working Group of Heart Failure*Henrike Arfsten, MDMedical University of Vienna, Vienna, Austria (H.A., G.G., N.P., M.H.), Georg Goliasch, MD, PhDMedical University of Vienna, Vienna, Austria (H.A., G.G., N.P., M.H.), Noemi Pavo, MD, PhDMedical University of Vienna, Vienna, Austria (H.A., G.G., N.P., M.H.), Hanno Ulmer, PhDMedical University of Innsbruck, Innsbruck, Austria (H.U.), Martin Hülsmann, MDMedical University of Vienna, Vienna, Austria (H.A., G.G., N.P., M.H.), and Thomas Stefenelli, MDDonauspital, Vienna, Austria (T.S.), on behalf of the Austrian Working Group of Heart Failure*Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-0476 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Current guidelines recommend specific dosages of β-blockers and renin–angiotensin system inhibitors for patients with heart failure with reduced ejection fraction, because patients who receive this treatment have fewer hospitalizations and live longer (1). However, many eligible patients do not receive the recommended dosage (2); one explanation is that clinicians prescribe lower dosages to avoid side effects. Drugs in the same class have different potencies and thus different recommended dosages. Thus, we wondered whether clinicians prescribe less of the recommended dosage for drugs with higher recommended dosages than those with lower recommended dosages because of an unconscious bias against higher ...References1. Ponikowski P, Voors AA, Anker SD, et al; ESC Scientific Document Group.. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: the task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37:2129-2200. [PMID: 27206819] doi:10.1093/eurheartj/ehw128 CrossrefMedlineGoogle Scholar2. Maggioni AP, Anker SD, Dahlström U, et al; Heart Failure Association of the ESC.. Are hospitalized or ambulatory patients with heart failure treated in accordance with European Society of Cardiology guidelines? Evidence from 12,440 patients of the ESC Heart Failure Long-Term Registry. Eur J Heart Fail. 2013;15:1173-84. [PMID: 23978433] doi:10.1093/eurjhf/hft134 CrossrefMedlineGoogle Scholar3. Kahneman D, Tversky A. Prospect theory: an analysis of decision under risk. Econometrica. 1979;47:263-91. CrossrefGoogle Scholar4. Kahneman D, Tversky A. On the psychology of prediction. Psychol Rev. 1973;80:237-51. CrossrefGoogle Scholar5. Poelzl G, Altenberger J, Pacher R, et al; Austrian Working Group on Heart Failure.. Dose matters! Optimisation of guideline adherence is associated with lower mortality in stable patients with chronic heart failure. Int J Cardiol. 2014;175:83-9. [PMID: 24857326] doi:10.1016/j.ijcard.2014.04.255 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Medical University of Vienna, Vienna, Austria (H.A., G.G., N.P., M.H.)Medical University of Innsbruck, Innsbruck, Austria (H.U.)Donauspital, Vienna, Austria (T.S.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0476.Reproducible Research Statement:Study protocol, statistical code and data set: Not available.This article was published at Annals.org on 1 October 2019.* Members of the Austrian Working Group of Heart Failure who contributed to this article but did not author it are listed in the Appendix. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byMUW researcher of the month 7 January 2020Volume 172, Issue 1Page: 70-72KeywordsAngiotensin converting enzyme inhibitorDrugsEjection fractionHeart failureObservational studiesOutpatientsPatient advocacyPopulation statisticsStatistical dataTreatment guidelines ePublished: 1 October 2019 Issue Published: 7 January 2020 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...