Retrospective Evaluation of Prescription Frequency in Heart Failure

Abstract

Background:

Current clinical guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA) recommend that all patients with heart failure, in the absence of absolute contraindications, be treated with both a β-blocker and an angiotensin-converting enzyme (ACE) inhibitor or angiotensin-receptor blocker (ARB). Despite guideline recommendations and strong evidence of mortality benefit, studies of practice patterns show suboptimal use of such drugs.

Objective:

To determine the frequency of ACE inhibitor or ARB and β-blocker combination therapy in patients diagnosed with heart failure.

Methods:

Medical records of patients diagnosed with heart failure through ICD-9 codes at an urban community health center were reviewed over a one year period to determine the frequency of use of β-blockers, ACE inhibitors, and ARBs. Data were classified according to patient characteristics and comorbid conditions.

Results:

Combination therapy with both a β-blocker and ACE inhibitor or ARB was used in 61.1% (107/175) of patients. Overall, 65.7% (115/175) of patients had no relative contraindications to therapy and were more likely to be prescribed combination therapy than those with contraindications (72.2% vs 40.0%; p < 0.001). Patients with relative contraindications to β-blocker therapy (chronic obstructive pulmonary disease, asthma) were less likely to be on combination therapy than patients without such contraindications (51.0% vs 81.0%; p < 0.001).

Conclusions:

Although a majority of patients were taking both a β-blocker and either an ACE inhibitor or ARB, a large number of patients were not prescribed appropriate ACC/AHA–recommended therapy. Interventions within health systems should be explored as a means to bridge this gap to improve patient outcomes and ensure quality of care.