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Evaluation of the prescribing practice of guideline-directed medical therapy among ambulatory chronic heart failure patients.
- Source :
-
BMC cardiovascular disorders [BMC Cardiovasc Disord] 2021 Feb 18; Vol. 21 (1), pp. 104. Date of Electronic Publication: 2021 Feb 18. - Publication Year :
- 2021
-
Abstract
- Background: Studies have demonstrated that heart failure (HF) patients who receive direct pharmacist input as part of multidisciplinary care have better clinical outcomes. This study evaluated/compared the difference in prescribing practices of guideline-directed medical therapy (GDMT) for chronic HF patients between two multidisciplinary clinics-with and without the direct involvement of a pharmacist.<br />Methods: A retrospective audit of chronic HF patients, presenting to two multidisciplinary outpatient clinics between March 2005 and January 2017, was performed; a Multidisciplinary Ambulatory Consulting Service (MACS) with an integrated pharmacist model of care and a General Cardiology Heart Failure Service (GCHFS) clinic, without the active involvement of a pharmacist.<br />Results: MACS clinic patients were significantly older (80 vs. 73 years, p < .001), more likely to be female (p < .001), and had significantly higher systolic (123 vs. 112 mmHg, p < .001) and diastolic (67 vs. 60 mmHg, p < .05) blood pressures compared to the GCHF clinic patients. Moreover, the MACS clinic patients showed more polypharmacy and higher prevalence of multiple comorbidities. Both clinics had similar prescribing rates of GDMT and achieved maximal tolerated doses of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in HFrEF. However, HFpEF patients in the MACS clinic were significantly more likely to be prescribed ACEIs/ARBs (70.5% vs. 56.2%, p = 0.0314) than the GCHFS patients. Patients with both HFrEF and HFpEF (MACS clinic) were significantly less likely to be prescribed β-blockers and mineralocorticoid receptor antagonists. Use of digoxin in chronic atrial fibrillation (AF) in MACS clinic was significantly higher in HFrEF patients (82.5% vs. 58.5%, p = 0.004), but the number of people anticoagulated in presence of AF (27.1% vs. 48.0%, p = 0.002) and prescribed diuretics (84.0% vs. 94.5%, p = 0.022) were significantly lower in HFpEF patients attending the MACS clinic. Age, heart rate, systolic blood pressure (SBP), anemia, chronic renal failure, and other comorbidities were the main significant predictors of utilization of GDMT in a multivariate binary logistic regression.<br />Conclusions: Lower prescription rates of some medications in the pharmacist-involved multidisciplinary team were found. Careful consideration of demographic and clinical characteristics, contraindications for use of medications, polypharmacy, and underlying comorbidities is necessary to achieve best practice.
- Subjects :
- Adult
Aged
Aged, 80 and over
Cardiovascular Agents adverse effects
Chronic Disease
Comorbidity
Drug Prescriptions
Drug Therapy, Combination
Drug Utilization trends
Female
Heart Failure diagnosis
Heart Failure epidemiology
Humans
Male
Middle Aged
Prevalence
Retrospective Studies
Risk Assessment
Risk Factors
South Australia epidemiology
Time Factors
Ambulatory Care trends
Ambulatory Care Facilities trends
Cardiovascular Agents therapeutic use
Guideline Adherence trends
Heart Failure drug therapy
Practice Guidelines as Topic
Practice Patterns, Physicians' trends
Subjects
Details
- Language :
- English
- ISSN :
- 1471-2261
- Volume :
- 21
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- BMC cardiovascular disorders
- Publication Type :
- Academic Journal
- Accession number :
- 33602125
- Full Text :
- https://doi.org/10.1186/s12872-021-01868-z