Prevalence of heart failure and adherence to process indicators: which socio-demographic determinants are involved?

: Interest in chronic conditions reflects their role as the first cause of death and disability
in developed countries; improving the management of these conditions is a priority for health care
services. The aim of this study was to establish which sociodemographic factors influence adherence
to standards of care for chronic heart failure (CHF). A generalized multilevel structural equation
model was developed and applied to a sample of patients with CHF obtained from administrative
data flows in six Italian regions to ascertain any associations between adherence to standards of care
for CHF and sociodemographic variables. Indicators of compliance were adherence to beta-blocker
therapy (BB-A) and Angiotensin Convertin Enzime inhibitor/Angiotensin Receptor Blocker therapy
(ACE-A), and creatinine and electrolyte testing (CNK-T). All indicators were computed over a
one-year follow-up. Among a cohort of 24,997 patients, the BB-A rate was 40.4%, the ACE-A rate
61.1%, and the CNK-T rate 57.0%. Factors found associated with adherence were gender, age, and
citizenship. Our study shows an inadequate adherence to standards of care for CHF, particularly
associated with certain sociodemographic characteristics. This suggests the need to improve the role
of primary care in managing this chronic condition. The measures considered only apply to patients
with a reduced Left Ventricular Ejection Fraction, hence a limitation of this analysis is the lack of
information on left ventricular ejection.
Keywords: primary health care; health care research