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Evaluation of the prescribing practice of guideline-directed medical therapy among ambulatory chronic heart failure patients


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Parajuli, DR, Shakib, S, Eng-Frost, J, McKinnon, RA, Caughey, GE and Whitehead, D ORCID: 0000-0003-4131-4594 2021 , 'Evaluation of the prescribing practice of guideline-directed medical therapy among ambulatory chronic heart failure patients' , BMC Cardiovascular Disorders, vol. 21, no. 1 , pp. 1-16 , doi: 10.1186/s12872-021-01868-z.

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Background: Studies have demonstrated that heart failure (HF) patients who receive direct pharmacist input as part of multidisciplinary care have better clinical outcomes. This study evaluated/compared the difference in prescribing practices of guideline-directed medical therapy (GDMT) for chronic HF patients between two multidisciplinary clinics-with and without the direct involvement of a pharmacist.Methods: A retrospective audit of chronic HF patients, presenting to two multidisciplinary outpatient clinics between March 2005 and January 2017, was performed; a Multidisciplinary Ambulatory Consulting Service (MACS) with an integrated pharmacist model of care and a General Cardiology Heart Failure Service (GCHFS) clinic, without the active involvement of a pharmacist.Results: MACS clinic patients were significantly older (80 vs. 73 years, p p p p p = 0.0314) than the GCHFS patients. Patients with both HFrEF and HFpEF (MACS clinic) were significantly less likely to be prescribed β-blockers and mineralocorticoid receptor antagonists. Use of digoxin in chronic atrial fibrillation (AF) in MACS clinic was significantly higher in HFrEF patients (82.5% vs. 58.5%, p = 0.004), but the number of people anticoagulated in presence of AF (27.1% vs. 48.0%, p = 0.002) and prescribed diuretics (84.0% vs. 94.5%, p = 0.022) were significantly lower in HFpEF patients attending the MACS clinic. Age, heart rate, systolic blood pressure (SBP), anemia, chronic renal failure, and other comorbidities were the main significant predictors of utilization of GDMT in a multivariate binary logistic regression.Conclusions: Lower prescription rates of some medications in the pharmacist-involved multidisciplinary team were found. Careful consideration of demographic and clinical characteristics, contraindications for use of medications, polypharmacy, and underlying comorbidities is necessary to achieve best practice.

Item Type: Article
Authors/Creators:Parajuli, DR and Shakib, S and Eng-Frost, J and McKinnon, RA and Caughey, GE and Whitehead, D
Keywords: heart failure, ejection fraction, guideline-directed medical therapy, pharmacist, multidisciplinary, comorbidities
Journal or Publication Title: BMC Cardiovascular Disorders
Publisher: BioMed Central
ISSN: 1471-2261
DOI / ID Number: 10.1186/s12872-021-01868-z
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Copyright 2021 The Authors. Licensed under Creative Commons Attribution 4.0 International (CC BY 4.0)

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