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Are we optimizing medical therapy during a heart failure hospitalisation ?

Session Poster Session 3

Speaker Kim Girard

Event : Heart Failure 2019

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

Authors : K Girard (Sherbrooke,CA), H Provencher Couture (Sherbrooke,CA), F Dupont (Sherbrooke,CA), N Desgagnes (Sherbrooke,CA), SL Lepage (Sherbrooke,CA)

Authors:
K Girard1 , H Provencher Couture1 , F Dupont1 , N Desgagnes2 , SL Lepage1 , 1University Hospital of Sherbrooke (CHUS) - Sherbrooke - Canada , 2Sherbrooke University - Sherbrooke - Canada ,

Citation:

Background
Over the past 20 years, number of guideline recommended medical therapies have been added to our therapeutic arsenal for heart failure with reduced ejection fraction (HFrEF). Despite their proven efficacy, prescription rates of such medications are still less than optimal and every opportunity should be taken to improve them.

Purpose
This study aim to establish if clinicians take an acute decompensated heart failure (ADHF) hospitalisation as an opportunity to optimise the patient’s heart failure medication. 

Methods
Consecutive patients hospitalized for ADHF with LVEF = 40% between January 1st and December 31st 2015 (n=124) were identified using our institution’s database. All of their files were reviewed for their baselines characteristics and their heart failure treatment at admission and at discharge.

Results 
Most of our patients were male (61%) with a mean age of 77 ± 11 years old. The mean LVEF was 28% ± 9% and the underling cause being ischemic cardiopathy in the majority (65%) of patients. 32% of them ad a new diagnosis of HFrEF and the median length of hospital stay was 10 days. At admission, the prescription rate of beta blockers (ß-blockers), angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARB) and mineralocorticoid receptor antagonists (MRA) were 71%, 54% and 21% respectively vs 87% for ß-blockers, 63% for ACEI/ARB and 44% for MRA at hospital discharge. Only 10% of the patient had all three medication classes prescribed at admission vs 27% at discharge. Figure 1 show the prescription rate of the different heart failure medication. Only a small proportion of patients were prescribed the guideline recommended dose of ß-blockers (23%) and MRA (2%) at admission and this proportion only slightly increased at discharge (27% and 8% respectively).

Conclusion 
Although an episode of ADHF is an important moment to try to optimise disease modifying drug for our patients it is seldom the case. Prescription rate of guideline directed medical therapies significantly increased but was still less than optimal and dosage optimisation of already prescribed heart failure medication was low. To improve cardiovascular morbidity and mortality this gap should be address.

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