589 Medication Prescribing for Patients Undergoing Cardiac Surgery with Heart Failure with Reduced Ejection Fraction (HFrEF) and Review of Left Ventricular (LV) Function Documentation - A Departmental Audit

Abstract

Abstract Aim This study aims to audit the prescribing practices for patients with heart failure with reduced ejection fraction (HFrEF) who have undergone cardiac surgery at our department in accordance with European Society for Cardiology (ESC) guidelines for titrating heart failure medication in this cohort of patients. Method Data was collected from patients (n = 217) who have undergone cardiac surgery at our department between 20 May 2021 to 20 August 2021. This was collected from Tomcat Systems (Philips) and left ventricular ejection fraction (LVEF) was noted. ESC guidelines define HFrEF as LVEF≤40% and 15 patients met this criterion. These patients had their medications and electronic patient records reviewed to assess whether they are prescribed, considered for titration, or had a contraindication to the following medications (grouped as compliance rate) as per the 2016 ESC guidelines: ACE-inhibitor (or Angiotensin Receptor-Neprilysin Inhibitor - ACEi/ARNI), beta-blocker (BB) and mineralocorticoid receptor antagonist (MRA). Results This audit found a compliance rate of 67% (10/15) patients for ACEi/ARNI, 80% (12/15) patients for BB and 67% (10/15) patients for MRA. Following a departmental meeting, significant barriers were identified to optimal prescribing of these medications including lack of LVEF information readily available for ward round, lack of awareness and miscommunication of responsibility. Conclusions Having identified the challenges to optimal titrating of these medications, we have implemented interventions to improve communication of LVEF status to the clinical team. We have also encouraged the referral of these patients to heart failure clinic. The next cycle of audit will assess the efficacy of these changes.