Guidelines
have been published for management of chronic systolic heart failure
to reduce patient morbidity and mortality.
Objective: A quality review of the heart failure medical therapy
for a community family medicine residency program clinic and a
multidisciplinary heart failure specialty clinic was performed
to compare adherence to ACC/AHA heart failure guidelines, with
regard to medications and in titrating to recommended target doses.
Methods: The study was a retrospective chart review and data collected
included name and dose of any ACEI, beta-blocker, ARB, or other
medication addressed in the guidelines.
Results: Specialty clinic patients had significantly lower systolic
blood pressures and ejection fractions. Significantly more patients
were prescribed beta-blockers in the specialty clinic population
(98% vs 80%, p<0.05). Both patient populations had very low
rates of reaching target beta-blocker doses (15% vs 21%, p=0.27).
More patients in the family medicine clinic reached target doses
of ACEI (64% vs 49%, p<0.05) and ARBs (67% vs 35%, p<0.05).
Conclusions: This study revealed the vast majority of patients
in either a community family medicine residency program or heart
failure specialty clinic were prescribed ACEI or ARB, and beta-blockers.
However, achieving target doses should continue to be an important
goal for practitioners.
