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The dangers of non-heart failure hospitalisation for heart failure patients: frequent medication changes without follow up

Session Poster Session 2

Speaker Ethel O'Donoghue

Event : Heart Failure 2019

  • Topic : heart failure
  • Sub-topic : Pharmacotherapy
  • Session type : Poster Session

Authors : E O' Donoghue (Dublin,IE), A Brennan (Dublin,IE), C O' Dowling (Dublin,IE), J Mc Cormick (Dublin,IE), R Trueick (Dublin,IE), A Mc Hugh (Louth,IE), K Mc Donald (Dublin,IE)

E O' Donoghue1 , A Brennan1 , C O' Dowling1 , J Mc Cormick1 , R Trueick1 , A Mc Hugh2 , K Mc Donald1 , 1St Vincent's University Hospital - Dublin - Ireland , 2Dundalk Institute of Technology, Department of Nursing, Midwifery and Health Studies - Louth - Ireland ,

Chronic Heart Failure: Pharmacotherapy

Introduction: Pharmacotherapy in heart failure (HF) has become increasingly complex with each patient’s prescription the product of weeks or months of careful titration. The admission to hospital of HF patients for non-cardiac issues may lead to medication changes (MC) for reasons that may be either indicated or potentially inappropriate. Failure to communicate MC to the HF or cardiology team during admission or to arrange follow up with HF services may leave the patient exposed to potentially adverse outcomes.

Purpose: This study set out to examine the frequency with which HF MC occurred when patients who attend the heart failure unit (HFU) are admitted to hospital for non-cardiovascular reasons. Additionally we determined whether a rationale was documented and if patients were informed of the changes. Where changes were identified, appropriate follow up in HFU was arranged.

Methods: In an ongoing prospective single-centre observational study, we reviewed a daily list of admissions via the Emergency Department for patients that attend the HFU. Discharge notes were screened to assess if MC were made, and if so, whether there was a documented rationale for the change. Following this a phone call was made to the patient in order to assess their understanding of the change in HF therapy.

Results: To date, from a total of 584 non-HF admissions we randomly selected 73 patient charts. Fifty percent of patients carried a diagnosis of HFrEF (Heart Failure with Reduced Ejection Fraction) and 50% of patients were diagnosed with HFpEF (Heart Failure with Preserved Ejection Fraction). Patients studied had an average age of 74.6 years and an average length of stay of 10 days. Dominant cause for admission was respiratory infection. We noted a MC in 52% (n=38) of patients. Diuretics were the agents most frequently changed in 42% of cases (n=16). Changes were noted also in beta blockade (n=10), ACE inhibitors/ARBs (n=10), MRAs (n=1) and nitrates (n=1). There was no contact with the cardiology service in regard to any of these changes. A documented rationale was noted in 65% of cases (n=25). To date phone calls have been made to 27 patients who had MC. Of these, 44% (n=12) stated that their admitting teams knew of their attendance at HFU. Fifty one percent of patients (n=14) were aware that MC occurred, while 25% (n=7) had these changes explained to them. No patients were advised to follow up with the HFU.

Conclusion: The incidence of MC is high in this vulnerable patient cohort when they are admitted to hospital for non-cardiovascular reasons. While there is a stated rationale in many cases, these alterations were not discussed with cardiology service, and follow up with the HFU was not requested. This sequence of events may leave patients susceptible to adverse HF events following discharge from hospital. In an effort to guard against such events we recommend closer links are established between services both in hospital and at outpatient level.

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