| Related Articles |
Medication Initiation Burden Required to Comply with Heart Failure Guideline Recommendations and Hospital Quality Measures.
Circulation. 2015 Aug 27;
Authors: Allen LA, Fonarow GC, Liang L, Schulte PJ, Masoudi FA, Rumsfeld JS, Ho PM, Eapen ZJ, Hernandez AF, Heidenreich PA, Bhatt DL, Peterson ED, Krumholz HM, American Heart Association's Get With The Guidelines Heart Failure (GWTG-HF) Investigators
Abstract
BACKGROUND: -Guidelines for heart failure (HF) recommend prescription of guideline-directed medical therapy before hospital discharge; some of these therapies are included in publicly reported performance measures. The burden of new medications for individual patients has not been described.
METHODS AND RESULTS: -Get With The Guidelines-HF registry 2008-2013 collected prescribing, indications, and contraindications for angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB), beta-blockers (BB), aldosterone antagonists (AldA), hydralazine/isosorbide dinitrate (H/ISDN), and anticoagulants. The difference between a patient's medication regimen at hospital admission and that recommended by HF quality measures at discharge was calculated. Among 158,922 patients from 271 hospitals with a primary discharge diagnosis of HF, initiation of ACEI/ARB was indicated in 18.1% of all patients (55.5% of those eligible at discharge were not receiving ACEI/ARB at admission), BB in 20.3% (50.5% of eligible), AldA in 24.1% (87.4% of eligible), H/ISDN in 8.6% (93.1% of eligible), and anticoagulant in 18.0% (58.0% of eligible). Cumulatively, 0.4% of patients were eligible for 5 new medication groups, 4.1% for 4, 9.4% for 3, 10.1% for 2, and 22.7% for 1; 15.0% were not eligible for new medications because of adequate prescribing at admission; and 38.4% were not eligible for any medications recommended by HF quality measures. Compared with newly indicated medications (mean 1.45±1.23), actual new prescriptions were lower (mean 1.16±1.00).
CONCLUSIONS: -A quarter of patients hospitalized with HF need to start more than 1 medication to meet HF quality measures. Systems for addressing medication initiation and managing polypharmacy are central to HF transitional care.
PMID: 26316616 [PubMed - as supplied by publisher]