Medical therapy doses at hospital discharge in patients with existing and de novo heart failure

Abstract

Aims Uptitrating angiotensin‐converting enzyme inhibitors or angiotensin receptor blockers (ACE‐I/ARBs), beta‐blockers, and mineralocorticoid receptor antagonists (MRAs) to optimal doses in heart failure with reduced ejection fraction (HFrEF) is associated with improved outcomes and recommended in guidelines. Studies of ambulatory patients found that a minority are prescribed optimal doses. However, dose at hospital discharge has rarely been reported. This information may guide quality improvement initiatives during and following discharge. Methods and results We assessed 370 consecutive patients with HFrEF hospitalized at two centres in Vancouver, Canada. Of those without contraindications, 86.4%, 93.4%, and 44.7% were prescribed an ACE‐I/ARB/sacubitril–valsartan, beta‐blocker, or MRA, respectively. The proportion of eligible patients prescribed target dose was respectively 28.6%, 31.7%, and 4.1%. Forty‐two of 248 eligible patients (16.9%) were prescribed ≥50% of target dose, and only three patients received target dosing of all three medication classes. In multivariate regression models, cardiologist involvement in care was independently associated with increased dose and prescription of ≥50% of target dose for all medications, whereas a history of HF was only predictive for beta‐blockers. Conclusions In a single‐region experience of hospitalized HFrEF patients, a high proportion of eligible patients were discharged on ACE‐I/ARB or beta‐blocker. Less than half were prescribed MRAs, and few were prescribed ≥50% or target dosing of all medications. Further exploration into barriers to medication uptitration, and improvement in processes of care, is needed.

Association between the nurse-led program with mental health status, quality of life, and heart failure rehospitalization in chronic heart failure patients

“…First, through close follow-up at discharge, patients were more likely to adhere to guideline-directed medication therapy. [ 28 , 29 ] Indeed, in the current study, at the end of the follow-up, patients in the treatment group had higher rate of using betablocker and RAS inhibitor than the control group. Second, prior studies have shown that positive communication and interaction between healthcare worker and patients was associated with a better improvement of MHS.…”

Usefulness of a Nurse-Led Program of Care for Management of Patients with Chronic Heart Failure

“…Although advancements in medications and devices therapy have been achieved in the last decade, CHF remains the leading cause of cardiovascular-related death and incurs huge economic e920469-4 losses worldwide [2,18]. Prior studies have demonstrated that CHF patients have a low rate of adherence to guideline-directed medications therapy [19][20][21]. In addition, these patients also tend to have recurrent hospitalizations due to rapid progression and worsening of their condition.…”

Clinical inertia in the treatment of heart failure: a major issue to tackle

“…Forty-two of 248 eligible patients (16.9%) were prescribed ≥ 50% of target dose, and only three patients received target dosing of all three medication classes. Frequent contra-indications to therapy included renal dysfunction, hyperkalemia, hypotension, and bradycardia [ 28 ].…”