Use of an indicator to evaluate physician adherence to prescription guidelines for the treatment of heart failure

Abstract

The aim of this study was to use indicators to evaluate physician adherence to prescription guidelines for heart failure treatment in a university hospital. This was a prospective cohort study conducted in a university hospital. The information collected at the time of patient admission, including therapeutic indication, absolute contra indications and intolerance, was utilised for the formulation of a guideline adherence indicator (GAI). This indicator was calculated as follows: (the number of patients who used the medication/the number of eligible patients) x 100. The percentage of eligible patients was calculated using the following formula: (the number of eligible patients/the total number patients) x 100. The GAI was applied to a population of 53 patients. Inhibitors of angiotensin-converting enzyme/angiotensin receptor blocker (ACE-I/ARB) combination therapy were used in the greatest percentage of eligible patients (92.4%) and demonstrated the largest GAI value (73.5%). The percentages of patients who were eligible for beta-blockers, spironolactone and digitalis treatments were 81.1%, 52.8% and 60.4%, respectively. The GAI values for the use of beta-blockers, spironolactone and digitalis were 60.4%, 57.1% and 56.2%, respectively. For the studied patient population, the GAI was consistent with the proportion of patients who were eligible to receive digitalis and spironolactone.Uniterms: Heart failure/treatment. Health care. Clinical medicine/practice guidelines. Medicines/use. Medicines/prescriptions. O objetivo deste estudo foi utilizar indicadores para avaliar a adesão de médicos às diretrizes para tratamento da Insuficiência Cardíaca em um hospital universitário. Estudo de coorte prospectivo, conduzido em um hospital universitário. As variáveis coletadas na admissão do paciente foram: indicação terapêutica, contraindicações absolutas e intolerância, sendo utilizadas para elaboração de um indicador de adesão à diretriz (IAD). Este indicador foi calculado através da relação: (número de pacientes que utilizaram o medicamento/número de pacientes elegíveis) x 100. A % de pacientes elegíveis foi calculada da seguinte forma: (número de pacientes elegíveis/número total de pacientes) x 100. Os IAD foram aplicados para uma população de 53 pacientes. Os Inibidores da Enzima Conversora de Angiotensina/ Bloqueadores dos Receptores de Angiotensina foram as classes farmacológicas que apresentaram maior % de pacientes elegíveis (92,4%) e apresentaram o melhor IAD (73,5%). A % de pacientes elegíveis para beta-bloqueadores, espironolactona e digitálicos foi de 81,1%, 52,8% e 60,4%, respectivamente. O IAD para beta-bloqueadores foi 60,4%, espironolactona 57,1% e digitálicos 56,2%. Na população estudada, o IAD foi compatível com a proporção de pacientes elegíveis para digitálicos e espironolactona.Unitermos: Insuficiência cardíaca. Assistência à Saúde. Clinica médica/guia prático. Medicamentos/ uso. Medicamentos/prescrição.

A tool for assessment of heart failure prescribing quality: A systematic review and meta‐analysis

“…The characteristics of each included study are shown in Table 1 The studies reported the use of guideline adherence assessment tools in several different health care settings including 8 studies performed in ambulatory care, 18,21,25,27,[30][31][32][33] 6 studies in primary care, 22,24,26,28,32,34 and 7 studies in hospital inpatient settings. 21,23,26,27,29,31,35 Seven studies 18,25,27,[30][31][32]35 included a followup period of 6 to 12 months while two studies 21,23 reported a follow-up period of almost 2 years. Twelve studies were performed in Europe, 6 of which were performed in Germany.…”

“…18,21,22,[24][25][26][27][29][30][31][32]34,35 This tool has been modified in several ways since its publication, and only two studies used the original tool. 24,32 Modifications to the GAI include the consideration of contraindications to therapy, 21,22,24,26,27,29,30 recommended target doses, 22,30 general practitioner (GP) rationale, 26,34 and patients' socioeconomic level 26,29 as eligibility criteria for guideline adherence. While 11 studies reported GAI for both HFrEF and HFpEF patients, only one study reported the GAI results for each HF type.…”

“…Seven studies cited increasing age of HF patients 21,22,24,25,27,32,35 and 5 studies cited patient comorbidity burden. 21,24,30,34,35 Other barriers to guideline adherence identified were increasing NYHA class 24,27 and presence of obstructive lung disease, 22 CKD, 22,26,35 hypotension, 29,34,35 and bradycardia. 22,29,34 However, two studies reported that there was no explanation available for guideline nonadherence in 10% to 15% of patients in their populations.…”

“…21,24,30,34,35 Other barriers to guideline adherence identified were increasing NYHA class 24,27 and presence of obstructive lung disease, 22 CKD, 22,26,35 hypotension, 29,34,35 and bradycardia. 22,29,34 However, two studies reported that there was no explanation available for guideline nonadherence in 10% to 15% of patients in their populations. 26,35 3.10 | Clinical outcomes associated with GAI…”

“…Mortality risk associated with high GAI ranged from 5% to 13% while mortality risk associated with low GAI ranged from 10% to 21.5% (Log-rank P value < .005 each). On the other hand, 6 studies 18,21,25,29,30,35 reported mortality rates as mortality percentage in the whole population sample, high GAI and low GAI cohorts as 16.0 ± 8.1%, 7.6 ± 3.0%, and 33.9 ± 18.8%, respectively. Both approaches of mortality outcome measurement showed a significant mortality benefit of high GAI levels over low GAI levels.…”