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

Abstract

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.

Effects of sociodemographic and socioeconomic factors on stroke development in Lebanese patients with atrial fibrillation: a cross-sectional study

“…Similar findings were reported by Sabry et al regarding health and economic status during the COVID pandemic. 29 According to a population-based study of 11,247 Australian adults aged ≥25 years, and women with lower education were associated with a higher risk of metabolic disorders manifested by hyperinsulinemia, hypertriglyceridemia, abdominal obesity and hypertension that trigger the risk of cardiovascular occurrence. 30 According to the literature, a low educational level is associated with poor health because of the limited access, and lack of comprehensive understanding of health-related information.…”

“…1 The global crude death rate per 100,000 population of high-income, upper and lower-middle-income countries due to stroke is the second-highest following coronary heart disease. 2,3 In Lebanon, NCDs are the major cause of death and disability and are expected to be responsible for 91% of deaths by 2025. 4 NCDs are susceptible to modifiable and non-modifiable risk factors that are known to trigger their development.…”

A comprehensive review on global contributions and recognition of pharmacy professionals amidst COVID-19 pandemic: moving from present to future

“…A study concluded that pharmacists experienced the highest rate of burnout due to excessive workloads compared to physicians and nurses even before the beginning of this pandemic period [ 60 , 93 ]. Despite appropriate recommendations made by the clinical pharmacists, physician’s reluctance to alter their colleague’s prescriptions adversely affected the role of pharmacists in a multidisciplinary team [ 94 ]. During COVID-19, pharmacists in Canada had spent 24% of their shift in dealing with medication shortages which placed a huge burden.…”

Effects of sociodemographic and socioeconomic factors on stroke development in Lebanese patients with atrial fibrillation: a cross-sectional study

“…- 1c) The role of pharmacists in NCD management might not be well elaborated in the Middle East. El Hadidi et al (2020 3 ) might be a good reference for pharmacists' role in NCD in limited resources. The real questionnaire should be attached as supplement material (even if in Arabic/French Language) for reproducibility.…”

“…- 1c) The role of pharmacists in NCD management might not be well elaborated in the Middle East. El Hadidi et al (2020 3 ) might be a good reference for pharmacists' role in NCD in limited resources.…”