Open Access Research article

Utilization of evidence-based treatment in elderly patients with chronic heart failure: using Korean Health Insurance claims database

Ju-Young Kim1, Hwa-Jung Kim2, Sun-Young Jung3, Kwang-Il Kim4, Hong Ji Song5, Joong-Yub Lee6, Jong-Mi Seong7 and Byung-Joo Park7*

  • * Corresponding author: Byung-Joo Park

  • † Equal contributors

Author Affiliations

1 Department of Family Medicine, Seoul National University Bundang Hospital, Seoul, Korea

2 Department of Clinical Epidemiology and Biostatics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

3 Korea Institute of Drug Safety and Risk Management, Seoul, Korea

4 Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea

5 Department of Family Medicine and Health Promotion Center, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si, Korea

6 Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea

7 Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea

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BMC Cardiovascular Disorders 2012, 12:60  doi:10.1186/1471-2261-12-60

Published: 31 July 2012



Chronic heart failure accounts for a great deal of the morbidity and mortality in the aging population. Evidence-based treatments include angiotensin-2 receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACE-I), beta-blockers, and aldosterone antagonists. Underutilization of these treatments in heart failure patients were frequently reported, which could lead to increase morbidity and mortality. The aim of this study was to evaluate the utilization of evidence-based treatments and their related factors for elderly patients with chronic heart failure.


This is retrospective observational study using the Korean National Health Insurance claims database. We identified prescription of evidence based treatment to elderly patients who had been hospitalized for chronic heart failure between January 1, 2005, and June 30, 2006.


Among the 28,922 elderly patients with chronic heart failure, beta-blockers were prescribed to 31.5%, and ACE-I or ARBs were prescribed to 54.7% of the total population. Multivariable logistic regression analyses revealed that the prescription from outpatient clinic (prevalent ratio, 4.02, 95% CI 3.31–4.72), specialty of the healthcare providers (prevalent ratio, 1.26, 95% CI, 1.12–1.54), residence in urban (prevalent ratio, 1.37, 95% CI, 1.23–1.52) and admission to tertiary hospital (prevalent ratio, 2.07, 95% CI, 1.85–2.31) were important factors associated with treatment underutilization. Patients not given evidence-based treatment were more likely to experience dementia, reside in rural areas, and have less-specialized healthcare providers and were less likely to have coexisting cardiovascular diseases or concomitant medications than patients in the evidence-based treatment group.


Healthcare system factors, such as hospital type, healthcare provider factors, such as specialty, and patient factors, such as comorbid cardiovascular disease, systemic disease with concomitant medications, together influence the underutilization of evidence-based pharmacologic treatment for patients with heart failure.

Congestive heart failure; Drug utilization evaluation; Elderly; Type 2 angiotensin receptor antagonists; Angiotensin-converting enzyme antagonists; Beta-adrenergic blockers