Emergency Department Use of Heart Failure-Exacerbating Medications in Patients with Chronic Heart Failure

IF 4 2区 医学 Q1 PHARMACOLOGY & PHARMACY
Martin F. Casey, Joy Hallmark, Patricia P. Chang, Jo E. Rodgers, Aakash Mehta, Srihari V. Chari, Preston Skersick, Thomas Bohrmann, Parag Goyal, Michelle L. Meyer
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Abstract

Background

Use of heart failure-exacerbating medications (HFEMs) may lead to preventable episodes of acute decompensated heart failure (HF). HFEMs use is common in patients with HF, and there may be opportunities to reduce their use from the emergency department (ED).

Methods

We performed an observational study on patients with HF presenting to EDs within a healthcare system between 1 January 2016 and 31 December 2020. Patients with chronic HF were identified using diagnostic codes within the electronic health record. The cohort was restricted to ambulatory (i.e., discharged to home) ED encounters. Medications, either ordered in the ED or prescribed at ED discharge, were extracted from the medication administration record and identified as potential HFEMs based on the 2016 American Heart Association Scientific Statement. Descriptive statistics were used to summarize the prevalence of HFEM use during ambulatory ED encounters. Exploratory analyses to identify correlates of HFEM use were performed.

Results

The study cohort included 23,907 ED encounters. ED administration or prescription of HFEMs occurred during 20% of ambulatory ED encounters. HFEM administration in the ED (17%) was more common than HFEM prescription at ED discharge (6%). The most common HFEMs administered in the ED included nonsteroidal anti-inflammatory drugs (11%) and albuterol (7%).

Conclusion

HFEM use is common in patients with HF seeking ED care, occurring in roughly one-fifth of ambulatory ED encounters. There may be opportunities to optimize medication use among patients with HF in the ED.

Abstract Image

慢性心力衰竭患者在急诊科使用加重心力衰竭药物的情况
背景心衰加重药物(HFEMs)的使用可能会导致可预防的急性失代偿性心衰(HF)发作。我们对 2016 年 1 月 1 日至 2020 年 12 月 31 日期间在医疗系统内急诊科就诊的高血压患者进行了一项观察性研究。慢性心房颤动患者通过电子健康记录中的诊断代码进行识别。队列仅限于门诊(即出院回家)急诊室就诊患者。从用药记录中提取急诊室处方或急诊室出院时处方的药物,并根据 2016 年美国心脏协会科学声明将其识别为潜在的 HFEMs。描述性统计用于总结门诊急诊室就诊期间高频电磁干扰药物的使用率。研究队列包括 23907 次急诊室就诊。20%的非住院急诊就诊者在急诊室使用或开具了 HFEM。在急诊室使用 HFEM 的比例(17%)高于急诊室出院时开具 HFEM 处方的比例(6%)。在急诊室使用的最常见的高频电磁干扰药物包括非甾体抗炎药(11%)和阿布特罗(7%)。在急诊室就诊的高血压患者中,可能存在优化用药的机会。
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来源期刊
Drug Safety
Drug Safety 医学-毒理学
CiteScore
7.60
自引率
7.10%
发文量
112
审稿时长
6-12 weeks
期刊介绍: Drug Safety is the official journal of the International Society of Pharmacovigilance. The journal includes: Overviews of contentious or emerging issues. Comprehensive narrative reviews that provide an authoritative source of information on epidemiology, clinical features, prevention and management of adverse effects of individual drugs and drug classes. In-depth benefit-risk assessment of adverse effect and efficacy data for a drug in a defined therapeutic area. Systematic reviews (with or without meta-analyses) that collate empirical evidence to answer a specific research question, using explicit, systematic methods as outlined by the PRISMA statement. Original research articles reporting the results of well-designed studies in disciplines such as pharmacoepidemiology, pharmacovigilance, pharmacology and toxicology, and pharmacogenomics. Editorials and commentaries on topical issues. Additional digital features (including animated abstracts, video abstracts, slide decks, audio slides, instructional videos, infographics, podcasts and animations) can be published with articles; these are designed to increase the visibility, readership and educational value of the journal’s content. In addition, articles published in Drug Safety Drugs may be accompanied by plain language summaries to assist readers who have some knowledge of, but not in-depth expertise in, the area to understand important medical advances.
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