Key result
Among hospitalized heart failure patients not in specialist programs, only 59% were prescribed ACE inhibitors and 43% beta-blockers on discharge.
Observational (n=81)
There is a significant practice gap in the optimal medical management of heart failure patients not under specialist care, highlighting an opportunity for pharmacist-led medication management.
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Suboptimal ACE inhibitor and beta-blocker prescribing persists outside specialist HF programs; leaves open whether pharmacist-led interventions improve guideline-directed therapy uptake.
Aim To review the management of heart failure in patients not enrolled in specialist multidisciplinary programs. Method A prospective clinical audit of patients admitted to hospital with either a current or past diagnosis of heart failure and not enrolled in a specialist heart failure program or under the direct care of the cardiology unit. Results 81 eligible patients were enrolled (1 August to 1 October 2008). The median age was 81 ± 9.4 years and 48% were male. Most patients (63%) were in New York Heart Association Class II or Class III heart failure. On discharge, 59% of patients were prescribed angiotensin converting enzyme inhibitors and 43% were prescribed beta‐blockers. During hospitalisation, 8.6% of patients with a past diagnosis of heart failure were started on an angiotensin converting enzyme inhibitor and 4.9% on a beta‐blocker. There was evidence of suboptimal dosage on admission and discharge for angiotensin converting enzyme inhibitors (19% and 7.4%) and beta‐blockers (29% and 17%). The results compared well with international reports regarding the under‐treatment of heart failure. Conclusion The demonstrated practice gap provides excellent opportunities for the involvement of pharmacists to improve the continuation of care for heart failure patients discharged from hospital in the areas of medication management review, dose titration and monitoring.
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Borgstedt et al. (2009) conducted an observational in Heart failure (n=81). Non-specialist heart failure management was evaluated on Prescription rates of ACE inhibitors and beta-blockers on discharge. Among hospitalized heart failure patients not in specialist programs, only 59% were prescribed ACE inhibitors and 43% beta-blockers on discharge.
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