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Factors influencing guideline-led prescribing to heart failure patients in an Egyptian critical care setting

Session Poster Session 4

Speaker Seif El Hadidi

Event : Heart Failure 2019

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

Authors : S El Hadidi (Cork,IE), N Bazan (Cairo,EG), E Darwesh (Cairo,EG), S Byrne (Cork,IE), M Bermingham (Cork,IE)

S El Hadidi1 , N Bazan2 , E Darwesh3 , S Byrne1 , M Bermingham1 , 1University College Cork, School of Pharmacy - Cork - Ireland , 2Cairo University, Clinical Pharmacy Department, Critical Care Medicine Department - Cairo - Egypt , 3Future University in Egypt , Faculty of Pharmaceutical Sciences and Pharmaceutical Industries - Cairo - Egypt ,


Introduction: Heart Failure represents a crucial issue for the healthcare systems in the Middle East and North Africa due to its considerable human and economic burden. Guideline-led prescribing improves HF patient outcomes, however little is known about the factors influencing guideline-led prescribing to HF patients in Egypt.

Purpose: To assess the knowledge and behaviours of medical doctors towards prescribing to HF patients and to investigate potential barriers and facilitators to HF guideline-led prescribing in an Egyptian setting.

Methods: An 11-item survey was disseminated in hardcopy and electronically to all medical doctors (n=62) at the Critical Care Medicine Department, Cairo University Hospitals, Egypt from July – November 2018. Doctors were classified as Associate Staff (Bachelor of Medicine holders) or Staff (postgraduate degree holders). Ten survey items were rated on a 5-point Likert scale. Likert questions were anchored, as appropriate, by very familiar/completely unfamiliar or always/never. Comparisons between groups were made using ?2 test or Fischer’s Exact test.

Results: Thirty-four doctors responded (54.3% response rate), of whom 15 (44.2%) were Staff. Overall, 82% of respondents reported that they use international clinical guidelines to inform prescribing practice (100% Staff vs. 66.7% Associate Staff, p =0.027). Staff were more familiar with ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2016 than associate staff (66.7% vs. 36.8%, p=0.012). Most respondents (76.5%) stated that they always/often comply with prescribing guidelines. Medication choice is discussed with the patient always/often by 44.1% of respondents, however, Staff were more likely to do so than Associate Staff (86.7% vs. 26.3%, p=0.036). Over 85% of prescribers always/often considered patients’ renal function and serum potassium when prescribing a loop diuretic or a renin-angiotensin system inhibitor and >75% of prescribers always/often considered heart rate, blood pressure and pulmonary function when prescribing beta-blockers. The most frequently cited barriers to guideline-led prescribing were the absence of local guidelines (79.4%); the cost of medication to patients (76.5%); and absence of Egyptian national guidelines (67.6%). Associate Staff reported workload as a barrier to guideline-led prescribing more often than Staff did (52.3% vs. 13.3%, p=0.026). Two-thirds of respondents supported greater involvement of clinical pharmacists to improve guideline-led prescribing to HF patients in this setting.

Conclusion: Familiarity with international HF guidelines was high however experienced Staff were more likely to be familiar with and to implement prescribing guidelines than less experienced Associate Staff. Availability of local or national HF prescribing guidelines and greater involvement of clinical pharmacists provide opportunities to deliver optimised HF care in Egypt.

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