Evaluation of the Introduction of an American Guideline
on Pharmacotherapy of Chronic Heart Failure
(ACE Inhibition) in Hungary

Anna Müller1, Edit Paulik1, Éva Belicza2, Krisztina Boda3, and László Nagymajtényi1

1 Department of Public Health, University of Szeged, Hungary
2 Health Care Management Center, Semmelweis University, Budapest, Hungary
3 Department of Medical Informatics, University of Szeged, Hungary

Corresponding author: Dr. Anna Müller
    Department of Public Health
    University of Szeged
    Dóm tér 10.
    H-6720 Szeged, Hungary
    Telephone: +36-62-545-119
    Fax number: +36-62-545-120
    E-mail address: muller@puhe.szote.u-szeged.hu

CEJOEM 2002, Vol.8. No.2–3.:199–207

Key words:
Chronic heart failure, clinical guidelines, ACE inhibitors

Abstract:
The motivation for this research project has been the high cardiovascular morbidity of Central European populations. Its aim was to study the impact of an American clinical guideline in the pharmacotherapy of patients treated for chronic heart failure in Hungarian hospitals. The investigation involved all the patients who were admitted with heart failure or one of its primary diseases as the leading diagnosis. Out of a total of 1222 subjects, the Phase “before” involved 566, and the Phase “after”, 656 patients. The angiotensin converting enzyme (ACE) inhibitor therapy of the relevant patients was analyzed and compared prior to and following the introduction of the clinical guideline, using the so-called “before and after” controlled epidemiological investigation method. In the period following the introduction of the guideline, the total application of ACE inhibitors (classified by the active agents) increased from 64.7% to 70.3%. Before that, the individual institutions seemed to apply the various preparations with varying frequency, and the differences between the medication practices of the hospitals did not significantly decrease after the introduction of the guideline. In conclusion, in accordance with the recommendations of the guideline the application of ACE inhibitors increased significantly in the Phase “after”. However, neither the differences between the hospitals in pharmacotherapy nor the regional disproportion observed in Hungarian health care were reduced by introduction of the guideline.

Received:  30 October 2002
Accepted:  11 November 2002
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