Guideline-led prescribing to ambulatory heart failure patients in a cardiology outpatient service

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dc.check.date2022-01-07
dc.check.infoAccess to this article is restricted until 12 months after publication by request of the publisher.en
dc.contributor.authorEl Hadidi, Seif
dc.contributor.authorVaughan, Carl
dc.contributor.authorKerins, David
dc.contributor.authorByrne, Stephen
dc.contributor.authorDarweesh, Ebtissam
dc.contributor.authorBermingham, Margaret
dc.contributor.funderFuture University in Egypten
dc.contributor.funderUniversity College Corken
dc.date.accessioned2021-10-08T15:15:55Z
dc.date.available2021-10-08T15:15:55Z
dc.date.issued2021-01-07
dc.date.updated2021-10-08T14:18:49Z
dc.description.abstractBackground 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.en
dc.description.statusPeer revieweden
dc.description.versionAccepted Versionen
dc.format.mimetypeapplication/pdfen
dc.identifier.citationEl 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-zen
dc.identifier.doi10.1007/s11096-020-01220-zen
dc.identifier.endpage1089en
dc.identifier.issn2210-7711
dc.identifier.journaltitleInternational Journal of Clinical Pharmacyen
dc.identifier.startpage1082en
dc.identifier.urihttps://hdl.handle.net/10468/12077
dc.identifier.volume43en
dc.language.isoenen
dc.publisherSpringeren
dc.relation.urihttps://link.springer.com/article/10.1007%2Fs11096-020-01220-z
dc.rights© 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-zen
dc.subjectBeta-blockersen
dc.subjectGuideline adherence indexen
dc.subjectGuideline-directed medical therapiesen
dc.subjectGuideline-led prescribingen
dc.subjectHeart failureen
dc.subjectInappropriate prescribingen
dc.subjectRenin-angiotensin systemen
dc.titleGuideline-led prescribing to ambulatory heart failure patients in a cardiology outpatient serviceen
dc.typeArticle (peer-reviewed)en
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