Assessment of Prescriber Compliance with Established Heart Failure Guidelines at a Major Medical Center

Abstract

Purpose

Treatment guidelines for systolic heart failure (HF), therapy for which largely relies on the combination of renin-angiotensin-aldosterone system (RAAS) agents and beta-blockers, focus on decreasing morbidity and mortality, and increasing quality of life. The objective of this study is to assess prescriber compliance with these guidelines in designing patient medication regimens prior to hospital admission, at discharge, and at readmission if within 30 days at a 473-bed tertiary university hospital.

Methods

Of 162 patients with a primary diagnosis of HF, 62 were selected for a retrospective data collection utilizing a random number table. Ten with an ejection fraction greater than or equal to 50% were excluded. Regimens were classified as suboptimal (absence of RAAS agent or beta-blocker), optimal, or optimal at target doses.

Results

Prior to admission (N = 52), 81% were prescribed diuretics, 54% were prescribed beta-blockers (8% target dose), and 50% were prescribed RAAS agents (11% target dose). Overall, 36% were optimal regimens; 2% were optimal and at optimal doses. Upon discharge, these values were 58% and 2%, respectively. Discharge medications included diuretics (92%), beta-blockers (79%; 10% target dose), and RAAS agents (75%; 11% target dose). Of the nine (17%) readmitted within 30 days, 67% were receiving suboptimal therapy; none were at target doses.

Conclusions

Optimal HF regimens were less common upon admission (36%) and improved upon discharge (58%). Most patients readmitted within 30 days of discharge were receiving suboptimal therapy. Clinical pharmacists are in a position to provide continuing prescriber education regarding proven HF therapies and target titration end points, both in ambulatory and acute care arenas.