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Important heart failure medications are often underdosed
In Germany, almost two million people suffer from heart failure (heart failure). Medicines play an important role in the treatment of the disease. But researchers have now found that the medication needed is often prescribed in too low a dose.
As the Medical University (MedUni) Vienna reports, important medications for the treatment of heart failure are often prescribed in lower doses than the international guidelines. A study with the involvement of MedUni Vienna shows that the treating doctors over-cautiously administer the most common groups of medicines. The results were published in the specialist magazine "Annals of Internal Medicine".
Only a limited proportion of the patients received the prescribed doses
Heart failure, which experts call heart failure, is one of the most common diseases in western countries. According to the German Heart Foundation, around 1.8 million people are affected in Germany alone. "The treatment of chronic heart failure is based on different pillars," the foundation writes on its website. Medications, rhythmological therapies (elimination of a cardiac arrhythmia (atrial flutter) or the implantation of a pacemaker are important.
As reported by the MedUni Vienna, three drug groups (ACE inhibitors, beta blockers and angiotensin receptor blockers) are used, for which there are clear guidelines for dosage. In the current study, researchers at MedUni Vienna, together with experts from the Heart Failure Working Group of the Austrian Cardiological Society under the direction of Thomas Stefenelli, used the national Austrian Heart Failure Register (3,737 patient data) to investigate which doses are prescribed to outpatients.
They found that only a limited proportion of patients with chronic systolic heart failure received the prescribed doses during an observation period of twelve months. The majority of the patients were significantly below the therapeutically optimal dosage to be aimed for. This was particularly evident within a substance class with different numerical maximum doses to achieve the same effect.
For example, drugs with a higher target dose in absolute numbers (e.g. beta blockers 10mg vs 200mg) were prescribed in a significantly lower dose than recommended, while drugs with a lower numerical target dose were significantly more likely to be prescribed the maximum target dose.
Doctors' unconscious fear of overdose
Martin Hülsmann, cardiologist at the Medical University of Vienna, who played a key role in the study together with his colleague Henrike Arfsten, sees a cognitive bias as the reason: "We identify an unconscious fear of overdosage and fear of side effects from medications in the colleague, which are also in the team." evidence-based medicine continues to exist. This is particularly pronounced the higher the target dose of a drug and prevents the administration of the drug dose that has been tested as optimal in studies. ”
However, Hülsmann assumes that this over-caution is not a special problem of cardiological treatments, but that there is an over-cautious dosage when prescribing in other medical fields. "We would like further studies that track this 'bias' in other diseases as well."
The study authors therefore propose that the first step be to check these results in larger patient groups and other disease entities. If the results are confirmed, the authors recommend supplementing the recommendations based on milligram dosing with guidelines based on equivalence dosing. Correct dosing is important so that the medicinal products achieve their intended effect and, in this case, related to heart failure, those affected gain the best possible quality of life. (ad)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- Medical University of Vienna: Heart failure medication often underdosed, (accessed: October 1, 2019), Medical University of Vienna
- Annals of Internal Medicine: Prescription Bias in the Treatment of Chronic Systolic Heart Failure, (accessed: October 1, 2019), Annals of Internal Medicine
- German Heart Foundation: What exactly is heart failure ?, (accessed: October 1, 2019), German Heart Foundation