background image
[ 154 ]
OUTCOME MEASURES: Persistence with first-line single treatment, categorized as follows:
continuers: patients continuing the first-line medication for at least 1 year; combiners:
patients receiving an additional antihypertensive drug and continuing the initial medica-
tion; switchers: patients changing from the first-line to another class of antihypertensive
drug and discontinuing the initial treatment; discontinuers: patients stopping the first-line
treatment without having another prescription until the end of the follow-up. Primary
care costs were expressed as the cost of hypertension management per person-year of
follow-up. RESULTS: In the study cohort, 19.8% were continuers, 22.1% were combiners,
15.4% were switchers, and 42.6% were discontinuers. Continuation was greatest with
angiotensin II type 1 receptor blocking agents (25.2%), calcium channel blockers (23.9%)
and angiotensin-converting enzyme inhibitors (23.3%). Severe hypertension [hazards ra-
tio 1.30; 95% confidence interval (CI) 1.18 to 1.43] and severe health status (hazards
ratio 1.22; 95% CI 1.15 to 1.30) increased the risk of discontinuation. The likelihood of
needing an additional antihypertensive drug was associated with mild-to-severe baseline
blood pressure, diabetes (hazards ratio 1.20; 95% CI 1.06 to 1.36), and familial history of
cardiovascular disease (hazards ratio 1.24; 95% CI 1.10 to 1.39). Discontinuers accounted
for 22.4% of the total primary care cost. Initial treatment with angiotensin II type 1 re-
ceptor blocking agents and beta-blockers resulted in incremental primary care costs of
145.2 and 144.2, respectively, compared with diuretics. Combiners and switchers increa-
sed the primary care cost by 140.1 and 11.7, compared with continuers. CONCLUSION:
Persistence with first-line single antihypertensive drugs is extremely low during the first
year of treatment. Potential cost saving should be possible by reducing the high frequency
of discontinuation. Diuretics represent the least expensive therapeutic option, although
further investigations in the long-term are needed to analyse the effects of persistence on
therapeutic effectiveness and related costs.
27. Filippi A, Sessa E, Pecchioli S, Trifirņ G, Samani F, Mazzaglia G. Homecare for patients
with heart failure in Italy. Ital Heart J. 2005;6:573-7.
ABSTRACT. BACKGROUND; Heart failure (HF) represents an important health issue in
western countries, especially for the elderly, frail population. A number of HF patients
must usually be assisted at home. No information is available about the usual care of HF
patients in Italy. The aim of this study was to describe the characteristics of HF patients
receiving homecare in the Italian general practice. METHODS: A questionnaire was sent
to 320 general practitioners (GPs) involved in the Health Search project. Among these,
148 (46.2%) answered and 376 home-ridden HF patients (60.3% women, median age
85 years) were identified. RESULTS: 257 (57%) patients were in NYHA class III or IV. Mul-
tiple relevant concomitant diseases occurred in 326 (86.7%) subjects. Only 140 (37.2%)
patients were able to take their pills without any help; caregivers, mainly family members,
were required 24 hours a day in 78.7% of cases. The length of homecare was > 1 year
in 84.5% of cases. CONCLUSIONS: According to our data, thousands of HF patients are
usually assisted at home for long periods in Italy. This is a very old group of subjects with
heavy co-morbidity and a high need for continuous, prolonged assistance. Studies speci-
fically aimed at the care of HF patients are needed.
28. Filippi A, Vanuzzo D, Bignamini AA, Mazzaglia G, Cricelli C, Catapano AL.The database
of Italian general practitioners allows a reliable determination of the prevalence
of myocardial infarction
. Ital Heart J. 2005; 6:311-4.
ABSTRACT. BACKGROUND: To plan preventive intervention after myocardial infarction (MI)
the disease prevalence and the age and time from acute event of the index population
should be known. METHODS: We identified all the living patients with MI coded diagnosis
in the database of the Italian College of General Practitioners (Health Search Database-