Zusammenfassung:
Es wurde die Umsetzung der Leitlinien im Hinblick auf die medikamentöse Behandlung der chronischen systolischen Herzinsuffizienz bei 200 Patienten mit dilatativer Kardiomyopathie untersucht. Dabei ergab sich bezüglich der Häufigkeiten der leitliniengerecht verordneten Medikamente - im Vergleich zu Untersuchungen bei Patienten mit der allgemeinen Diagnose einer Herzinsuffizienz - eine recht hohe Leitlinienkonformität. Insbesondere ß-RI wurden vergleichsweise häufiger entsprechend der Leitlinien verordnet. Bei den Follow-up-Untersuchungen zeigten sich zudem Zunahmen der o.g. Verordnungshäufigkeiten und deutliche Dosissteigerungen in Bezug auf ACE-I, AT1-RI sowie ß-RI. Des Weiteren fiel im zeitlichen Verlauf von etwa fünf Jahren ein Anstieg der Verordnung von ß-RI auf, wohingegen sich in Bezug auf die anderen Medikamentenklassen kaum Veränderungen fanden. Dies könnte ein wachsendes Bewusstsein über die Bedeutung von ß-RI bei der Herzinsuffizienzbehandlung in den letzten Jahren widerspiegeln. Auch gab es Unterschiede bei der Behandlung zwischen den Geschlechtern. Frauen hatten niedrigere mittlere Dosierungen von ACE-I/ AT1-RI sowie ß-RI als Männer. Patienten im Alter ab 60 Jahren wurden zudem im Vergleich zu den jüngeren Patienten seltener entsprechend der Leitlinien therapiert. Insbesondere bezog sich dies auf die verwendeten Dosierungen von ß-RI. Weiterhin zeigten sich Behandlungsunterschiede in Abhängigkeit vom behandelnden Arzt. Patienten, die stationär oder ambulant im Krankenhaus behandelt wurden, erhielten häufiger eine leitliniengerechte Medikation als diejenigen, welche bei niedergelassenen Ärzten in Behandlung waren. Aufgrund teilweise recht kleiner Gruppengrößen konnten keine weiteren signifikanten Unterschiede festgestellt werden. Im Rahmen der multivariaten Auswertungen waren bei Einschluss der Therapeut und zum Zeitpunkt der Follow-up-Untersuchung das Alter unabhängige Prädiktoren für die globale Leitlinienkonformität. Weibliches Geschlecht und höheres Alter waren zudem unabhängig mit niedrigeren ß-RI-Dosen assoziiert. Mögliche Gründe hierfür könnten häufigere Medikamentenunverträglichkeiten sein. Perspektivisch besteht vor allem Raum für Verbesserungen hinsichtlich der Verordnung von AA sowie den Dosierungen von ACE-I, AT1-RI und ß-RI, insbesondere bei älteren Patienten sowie Frauen.
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