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Guideline-led prescribing to ambulatory heart failure patients in a cardiology outpatient service
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Date
2021-01-07
Authors
El Hadidi, Seif
Vaughan, Carl
Kerins, David
Byrne, Stephen
Darweesh, Ebtissam
Bermingham, Margaret
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Springer
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Abstract
Background Guidelines recommend heart failure (HF) patients be treated with multiple medications at doses proven to improve clinical outcomes. Objective To study guideline-led prescribing in an Irish outpatient HF population. Setting Cardiology Outpatient Clinic, Mercy University Hospital, Cork, Ireland. Methods Guideline-led prescribing was assessed using the Guideline Adherence Index (GAI-3), that considered the prescribing of ACE inhibitors and angiotensin receptor blockers; beta-blockers and mineralocorticoid receptor antagonists. The GAI-based target dose was calculated based on the prescription of ≥ 50% of the guideline-recommended target dose of each of the three GAI medications to HF patients with ejection fraction ≤ 40%. High-GAI was achieved by prescription of ≥ 2 GAI medicines. Potentially inappropriate prescribing was assessed using a HF-specific tool. Main outcome measure Heart failure guideline-led prescribing assessed using the GAI-3. Results A total of 127 HF patients, mean age 71.7 ± 13.1 years, were identified in the study. Seventy-one patients had ejection fraction ≤ 40%. Population mean GAI-3 was 65.8%. When contraindications to therapy are considered, the adjusted GAI-3 increased to 72.9%. The target dose GAI was 18.5%. High-GAI management was prescribed to 54 patients (76.1%). A potentially inappropriate medicine in HF was prescribed to 14 (19.7%) patients. Conclusion Most HF patients with ejection fraction ≤ 40% in this setting received optimal guideline-led prescribing however the proportion of patients achieving the target doses of these agents was suboptimal.
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Keywords
Beta-blockers , Guideline adherence index , Guideline-directed medical therapies , Guideline-led prescribing , Heart failure , Inappropriate prescribing , Renin-angiotensin system
Citation
El Hadidi, S., Vaughan, C., Kerins, D., Byrne, S., Darweesh, E. and Bermingham, M. (2021) 'Guideline-led prescribing to ambulatory heart failure patients in a cardiology outpatient service', International Journal of Clinical Pharmacy, 43(4), pp. 1082-1089. doi: 10.1007/s11096-020-01220-z
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© The Author(s), under exclusive licence to Springer Nature Switzerland AG part of Springer Nature 2021. This is a post-peer-review, pre-copyedit version of an article published in the International Journal of Clinical Pharmacy. The final authenticated version is available online at: http://dx.doi.org/10.1007/s11096-020-01220-z