A pharmacist-led heart failure stewardship initiative for guideline-directed medical therapy in hospitalized patients with reduced ejection fraction.

IF 1.6 Q3 PHARMACOLOGY & PHARMACY

Canadian Pharmacists Journal Pub Date : 2024-05-31 eCollection Date: 2024-07-01 DOI:10.1177/17151635241249952

Gemma-Dawn A MacDonald, Rochelle M Johnston, Andrew J Flewelling

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引用次数: 0

Abstract

Background: Heart failure with reduced ejection fraction (HFrEF) is a progressive disease with high rates of hospitalization and mortality. The Canadian Cardiovascular Society recommends treating patients with HFrEF with medications from 4 standard medication classes-this is known as guideline-directed medical therapy (GDMT). However, despite clear evidence and recommendations, GDMT agents are known to be underutilized in the HFrEF population.

Objective: To determine if the implementation of a prescriber-alert stewardship tool for hospitalized patients with HFrEF will increase the frequency of GDMT prescribing with all classes during hospitalization.

Methods: Utilization of GDMT in patients with HFrEF between admission and discharge pre- and post-implementation of a prescriber alert stewardship tool was compared. Patients admitted to a cardiology stepdown unit between January and April 2022 had a stewardship-alert tool placed on their chart for physician review, while those admitted during the same time frame 1 year prior did not.

Results: Following the use of a prescriber alert, there was a statistically significant increase in prescribing for β-blockers (38.1% to 95.2%; p < 0.001), mineralocorticoid receptor antagonists (9.5% to 66.7%; p < 0.001) and combination GDMT (9.5% to 52.4%; p = 0.004) from admission to discharge. A statistically significant increase in the prescribing of β-blockers (47.6% to 76.2%; p = 0.004) and angiotensin-converting enzyme inhibitors (21.4% to 40.5%; p = 0.008) was still observed without the use of the prescriber alert.

Conclusion: A pharmacist-led heart failure stewardship tool initiative increased uptake of GDMT in patients with HFrEF.

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以药剂师为主导的心力衰竭管理计划，为射血分数降低的住院患者提供指南指导下的药物治疗。

背景：射血分数降低型心力衰竭（HFrEF）是一种进展性疾病，住院率和死亡率都很高。加拿大心血管协会建议使用 4 类标准药物治疗射血分数降低型心力衰竭患者，这就是所谓的指南指导下的药物治疗（GDMT）。然而，尽管有明确的证据和建议，GDMT 药物在 HFrEF 患者中的使用率却很低：目的：确定对住院的 HFrEF 患者实施处方提醒管理工具是否会增加住院期间 GDMT 各类处方的使用频率：方法：比较了高频低氧血症患者在入院和出院期间使用 GDMT 的情况，以及使用处方警示管理工具前后的情况。2022年1月至4月期间入住心脏科降级病房的患者在其病历上放置了监管提示工具供医生查看，而一年前同一时段入院的患者则没有使用该工具：使用处方提醒后，从入院到出院，β-受体阻滞剂（从38.1%到95.2%；p < 0.001）、矿皮质激素受体拮抗剂（从9.5%到66.7%；p < 0.001）和GDMT联合用药（从9.5%到52.4%；p = 0.004）的处方量均有统计学意义的显著增加。在未使用处方提醒的情况下，β-受体阻滞剂（47.6% 到 76.2%；p = 0.004）和血管紧张素转换酶抑制剂（21.4% 到 40.5%；p = 0.008）的处方量仍有明显增加：结论：由药剂师主导的心力衰竭管理工具倡议提高了高频心力衰竭患者对 GDMT 的使用率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Canadian Pharmacists Journal PHARMACOLOGY & PHARMACY-

CiteScore

2.50

自引率

26.70%

发文量

期刊介绍： Established in 1868, the Canadian Pharmacists Journal is the oldest continuously published periodical in Canada. Our mission is to enhance patient care through advancement of pharmacy practice, with continuing professional development, peer-reviewed research, and advocacy. Our vision is to become the foremost journal for pharmacy practice and research.