We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Implementing the European Society Of Cardiology Guidelines for evidence based therapy in Heart failure: An audit of Pharmacotherapy at discharge from an Acute Hospital.
- Authors
Morrice, K.; Hastings, J.; McClements, B.
- Abstract
The consistent implementation of guidelines on the use of evidence-based drug therapy in heart failure patients remains a challenge in clinical practice. The purpose of this study was to determine the extent of this problem in a single centre that seeks to adhere to European Society of Cardiology guidelines (2005), to discern its possible causes and to assess whether there is a difference depending on LV systolic function. 281 consecutive patients (150 male, mean age 77 years) admitted between April 2005 and December 2006 were identified from the Mater Hospital Heart Failure database. Of these, 245 patients who had recent echocardiographic data available formed the study population: 154 (63%) had LV systolic dysfunction (LVEF < 40%) (Group LV-S) and 91 had relatively preserved systolic function (Group LV-P). Results: The groups were similar except for percentage with hypertension (LV-P 80% v LV-S 44%, p<0.001). Mortality was 10.4% in LV-S and 10.9% in LV-P (p NS). Mean serum creatinine was 149µmol/l in LV-S and 135µmol/l in LV-P on admission and 158 µmol/l and 141 µmol/l respectively at discharge. Review of the clinical records of 24 patients in LV-S not on treatment with ACEi/ARB at discharge revealed that 20 had significantly impaired renal function (mean serum creatinine 264 µmol/l), 2 had profound hypotension with initiation of ACEi, one had severe aortic stenosis and one self-discharged against advice. The proportion (%) of patients in each group on prognosis modifying medication on admission (A) and at discharge (D) were: Conclusions: In this single centre study, use of beta-blockers was very satisfactory. All LV-S patients were on treatment with ACEi/ARB or had a documented contra-indication, usually renal impairment. There appears to be scope for greater use of AA in LV-S. It was also interesting to note the frequent use of AA in heart failure with relatively preserved systolic function.
- Subjects
EVIDENCE-based medicine; HEART failure; DRUGS; CARDIAC contraction; AORTA; CREATININE
- Publication
Ulster Medical Journal, 2008, Vol 77, Issue 2, p137
- ISSN
0041-6193
- Publication type
Article