Comparison of chronic systolic heart failure guideline adherence for two ambulatory clinics

  • Sarah B. Dehoney
  • Lori M. Dickerson
  • Jean M. Nappi
Keywords: Heart Failure, Systolic, Drug Therapy, Guideline Adherence, United States

Abstract

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.

Downloads

Download data is not yet available.

References

1. American Heart Association. Heart Disease and Stroke Statistics- 2009 Update. Dallas, Texas: American Heart Association; 2009.

2. Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG, Jessup M, Konstam MA, Mancini DM, Michl K, Oates JA, Rahko PS, Silver MA, Stevenson LW, Yancy CW, Antman EM, Smith SC Jr, Adams CD, Anderson JL, Faxon DP, Fuster V, Halperin JL, Hiratzka LF, Jacobs AK, Nishimura R, Ornato JP, Page RL, Riegel B. ACC/AHA 2005 guideline update for the diagnosis and management of chronic heart failure in the adult: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure). Circulation. 2005;112:e154-e235.

3. Adams KF, Lindenfeld J, Arnold JMO, Baker DW, Barnard DH, Baughman KL, Boehmer JP, Deedwania P, Dunbar SB, Elkayam U, Gheorghiade M, Howlett JG, Konstam MA, Kronenberg MW, Massie BM, Mehra MR, Miller AB, Moser DK, Patterson JH, Rodeheffer RJ, Sackner-Bernstein J, Silver MA, Starling RC, Stevenson LW, Wagoner LE. HFSA 2006 Comprehensive Heart Failure Practice Guideline. J Card Fail. 2006;12:e1-122.

4. Indridason OS, Coffman CJ, Oddone EZ. Is specialty care associated with improved survival of patients with congestive heart failure? Am Heart J. 2003;145:300-309.

5. Ezekowitz JA, van Walraven C, McAlister FA, Armstrong PW, Kaul P. Impact of specialist follow-up in outpatients with congestive heart failure. CMAJ. 2005;172(2):189-194.

6. Gattis WA, Hasselblad V, Whellan DJ, O’Connor CM. Reduction in heart failure events by the addition of a clinical pharmacist to the heart failure management team: results of the pharmacist in heart failure assessment recommendation and monitoring (PHARM) study. Arch Intern Med. 1999;159:1939-1945.

7. Nordrehaug JE, Omsjo IH, Vollset SE. A 3-month double-blind cross-over study of the effect of benazepril and hydrochlorothiazide on functional class in symptomatic mild heart failure. J Intern Med. 1992;231:589-584.

8. Colfer HT, Ribner HS, Gradman A, Hughes CV, Kapoor A, Laidlaw JC. Effects of once-daily benazepril therapy on exercise tolerance and manifestations of chronic congestive heart failure. The benazepril heart failure study group. Am J Cardiol. 1992;70:354-358.

9. Tonkon M, Awan N, Niazi I, Hanley P, Baruch L, Wolf RA, Block AJ. A study of the efficacy and safety of irbesartan in combination with conventional therapy, including ace inhibitors, in heart failure. Int J Clin Pract. 2000;54(1):11-18.

10. Hudson M, Humphries K, Tu JV, Behlouli H, Sheppard R, Pilote L. Angiotensin II receptor blockers for the treatment of heart failure: a class effect? Pharmacotherapy. 2007;27(4):526-534.

11. Waagstein F, Bristow MR, Swedberg K, Camerini F, Fowler MB, Silver MA, Gilbert EM, Johnson MR, Goss FG, Hjalmarson A. Beneficial effects of metoprolol in idiopathic dilated cardiomyopathy. Metoprolol in dilated cardiomyopathy (MDC) trial study group. Lancet. 1993;342:1441-1446.

12. McAlister FA, Stewart S, Ferrua S, McMurray JJ. Multidisciplinary strategies for the management of heart failure patients at high risk for admission. J Am Coll Cardiol. 2004;44:810-819.

13. Koshman SL, Charrois TL, Simpson SH, McAlister FA, Tsuyuki RT. Pharmacist care of patients with heart failure: a systematic review of randomized trials. Arch Intern Med. 2008;168(7):687-694.

14. Gupta R, Tang WH, Young JB. Patterns of β-blocker utilization in patients with chronic heart failure: experience from a specialized outpatient heart failure clinic. Am Heart J. 2004;147:79-83.

15. Poole-Wilson PA, Swedberg K, Cleland JG, Di Lenarda A, Hanrath P, Komajda M, Lubsen J, Lutiger B, Metra M, Remme WJ, Torp-Pedersen C, Scherhag A, Skene A. Comparison of carvedilol and metoprolol on clinical outcomes in patients with chronic heart failure in the carvedilol or metoprolol European trial (COMET): randomized controlled trial. Lancet. 2003;362:7-13.

16. Gottlieb SS, Fisher ML, Kjekshus, Deedwania P, Gullestad L, Vitovec J, Wikstrand J. Tolerability of β-blocker initiation and titration in the metoprolol CR/XL randomized intervention trial in congestive heart failure (MERIT-HF). Circulation. 2002;105:1182-88.

17. Bristow MR, Gilbert EM, Abraham WT, Adams KF, Fowler MB, Hershberger RE, Kubo SH, Narahara KA, Ingersoll H, Krueger S, Young S, Shusterman N. Carvedilol produces dose-related improvements in left ventricular function and survival in patients with chronic heart failure. Circulation. 1996;94:2807-2816.
Published
2010-03-15
Section
Original Research