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

Hadidi, Seif El; Darweesh, Ebtissam; Byrne, Stephen; Bermingham, Margaret

doi:10.1002/pds.4430

Cited by 14 publications

(15 citation statements)

References 40 publications

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“…QUALIFY is an international registry that included Egyptian HF patients recently discharged primarily from cardiology settings rather than CCU settings. [32] A recent systematic review found that in studies published from 2005 to 2016, GAI-3 ranged from 14% to 95%, with a mean GAI-3 of 62.9% [31]. While the GAI-3 reported here is lower than this international mean [31], it is comparable to recently reported GAI-3 in Brazil (41%) [33] and Korea (43%) [34], however, these studies were conducted in different settings.…”

Section: Discussionsupporting

confidence: 58%

“…[ 32 ] A recent systematic review found that in studies published from 2005 to 2016, GAI-3 ranged from 14% to 95%, with a mean GAI-3 of 62.9% [ 31 ]. While the GAI-3 reported here is lower than this international mean [ 31 ], it is comparable to recently reported GAI-3 in Brazil (41%) [ 33 ] and Korea (43%) [ 34 ], however, these studies were conducted in different settings. The study population here is more acutely ill than others reported in the GAI literature and this represents a serious challenge to prescribers in comparison to ambulatory HF populations or HF populations hospitalized in non-critical care settings [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

“…The EBBBs in HF are bisoprolol, carvedilol, metoprolol succinate, and nebivolol [ 10 ]. The adjusted GAI-3 considered the patient’s contraindications to these therapies as outlined in the guidelines ( Table 1 ) [ 10 , 29 , 31 ]. The GAI-based target dose was calculated as a prescription of ≥50% of the guideline-recommended target dose of each of the three GAI medications ( Table 1 ) [ 10 , 30 ].…”

Section: Methodsmentioning

confidence: 99%

“…The GAI-based target dose was calculated as a prescription of ≥50% of the guideline-recommended target dose of each of the three GAI medications ( Table 1 ) [ 10 , 30 ]. The study population was then subdivided into those with High-GAI management; that is the prescription of ≥2 of the GAI-3 medications and those with Low-GAI management; that is the prescription of ≤1 GAI-3 medication [ 31 ].…”

Section: Methodsmentioning

confidence: 99%

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Heart Failure Prescribing Quality at Discharge from a Critical Care Unit in Egypt: The Impact of Multidisciplinary Care

et al. 2020

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Discharge prescriptions for heart failure (HF) patients may not adhere to the clinical practice guidelines. This study aimed to assess the impact of the clinical pharmacist as a member of a multidisciplinary team on the quality of prescribing to HF patients at discharge from a Critical Care Unit (CCU) in Egypt. This was a retrospective cohort study of HF patients discharged from the CCU between January 2013 and December 2017. Guideline Adherence Index (GAI-3) was used to assess guideline-directed prescribing at discharge. Multidisciplinary care was introduced to the CCU on 1 January 2016. The study included 284 HF patients, mean (±SD) age 66.7 ± 11.5 years, 53.2% male. Heart failure with reduced ejection fraction affected 100 patients (35.2%). At discharge, loop diuretics were prescribed to 85.2% of patients; mineralocorticoid receptor antagonists to 54.9%; angiotensin-converting enzyme inhibitors/angiotensin receptor blockers to 51.4%; and β-blockers to 29.9%. Population Guideline Adherence Index (GAI-3) was 45.5%. High-GAI was prescribed to 136 patients (47.9%). Patients with High-GAI were younger; less affected by chronic kidney disease and had fewer comorbidities than those without High-GAI. Prescription of β-blocker increased (24.1% vs. 38.6%, p < 0.001) and digoxin utilization decreased (34.7% vs. 23.7%, p < 0.049) after the introduction of the multidisciplinary care. The inclusion of a clinical pharmacist in the multidisciplinary care team may have a role in optimizing the prescribing of HF guideline-directed therapies at discharge from this setting.

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Section: Discussionsupporting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Heart Failure Prescribing Quality at Discharge from a Critical Care Unit in Egypt: The Impact of Multidisciplinary Care

et al. 2020

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“…Одним из вариантов, уже получившим признание в мировой практике, является использование комплексных показателей (индексов), отражающих соответствие фактически проводимого фармакологического лечения положениям КР, прежде всего, в отношении препаратов, обязательных к назначению в той или иной клинической ситуации (рекомендации класса I). Композитная оценка приверженности (composite performance score) в нескольких модификациях используется как ключевой индикатор качества в программе Американской ассоциации сердца, направленной на оптимизацию фармакотерапии пациентов, перенесших ИМ -«Get With The Guidelines (GWTG)» [13] [14]. Известен отечественный опыт применения похожего подхода, но в популяции пациентов, перенесших инсульт [15].…”

Section: результаты и обсуждениеunclassified

Multivariable Analysis of Primary Care Physician Adherence to Guideline-recommended Pharmacotherapy of Stable Coronary Artery Disease

Zyryanov

Fitilev

Vozzhaev

et al. 2021

Racionalʹnaâ farmakoterapiâ v kardiologii

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Aim. To study predictors of primary care physician adherence to guideline-recommended pharmacotherapy of stable coronary artery disease.Material and methods. This pharmacoepidemiologic cross-sectional study was conducted in primary care setting of Moscow. 805 patients (mean age 68.9±9.9 years, males 51.4%) with established stable coronary artery disease (SCAD) were included. Demography, medical history, prescribed pharmacological treatment data were obtained. Physician adherence to guideline-recommended pharmacotherapy (GRP) of SCAD was evaluated based on the Class I guideline recommendations. Pharmacotherapeutic guideline adherence index (PGAI) was introduced as composite quality indicator, calculated in line with “all-or-none” rule and in regard with documented contraindications. To search for predictors of adherence the patient population was divided in two groups by level of physician adherence measured by PGAI. Statistical analysis was performed by IBM SPSS Statistics 16.0, the level of statistical significance was set at p<0.05.Results. The prescription rates of essential drug therapies of SCAD (regarding contraindications) were quite adequate: beta-blockers/calcium channel blockers – 90,1%, acetylsalicylic acid/clopidogrel/oral anticoagulants – 95,7%, statins/ezetimibe – 86,3%, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers – 87,6%. 82,9% (n=667) of patients were prescribed treatment for SCAD in compliance with the guidelines. Suboptimal pharmacotherapy was identified in 17,1% (n=138) of patients. These groups were similar in sex distribution (males 50,4 vs. 56,5%; p=0,188). Mean age tended to be lower in GRP adherent group (68,5±9,9 vs. 70,6±10,0 years; p=0,052). Bivariable analysis showed that good adherence to guideline-recommended pharmacotherapy was associated with higher prevalence of stable angina (66,4 vs. 53,6%; p=0,004), arterial hypertension (93,3 vs. 79,7%; p<0,001) and dyslipidemia (21,4 vs. 9,4%; p<0,001) and with lower prevalence of myocardial infarction (48,1 vs. 67,4%; p<0,001). Logistic multivariable regression model (gender, age, 6 medical history variables) identified 6 patient-related factors that were significantly associated with physician adherence to guideline-recommended pharmacotherapy: age (odds ratio [OR] 0,97; 95% confidence interval [CI] 0,95-0,99; p=0,009), arterial hypertension (OR 3,89; 95%CI 2,19-6,90; p<0,001), dyslipidemia (OR 2,31; 95%CI 1,23-4,34; p=0,009), chronic heart failure (OR 1,95; 95%CI 1,06-3,61; p=0,032), revascularization (OR 2,14; 95%CI 1,33-3,45; p=0,002), myocardial infarction (OR 0,28; 95%CI 0,16-0,48; p<0,001).Conclusion. Primary care cardiologist adherence to guideline-recommended pharmacotherapy of SCAD was satisfactory evaluated as 82,9% by composite indicator PGAI. Arterial hypertension, heart failure, dyslipidemia и revascularization were predictors of better physician adherence. History of myocardial infarction and older age were risk factors of non-adherence. Identification of patient-related factors associated with underperformance may facilitate tailoring quality improvement interventions in primary care of coronary patients.

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Factors associated with non-use and sub-target dosing of medical therapy for heart failure with reduced ejection fraction

et al. 2021

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

Cited by 14 publications

References 40 publications

Heart Failure Prescribing Quality at Discharge from a Critical Care Unit in Egypt: The Impact of Multidisciplinary Care

Heart Failure Prescribing Quality at Discharge from a Critical Care Unit in Egypt: The Impact of Multidisciplinary Care

Multivariable Analysis of Primary Care Physician Adherence to Guideline-recommended Pharmacotherapy of Stable Coronary Artery Disease

Factors associated with non-use and sub-target dosing of medical therapy for heart failure with reduced ejection fraction

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