Abstract
Background: A Gap remains between evidence-based guidelines in the treatment of heart failure and current pharmacologic and device therapy. Current performance measures for Heart Failure are designed to assess medication prescription but fail to address the need to achieve optimal pharmacology dosing. Methods: We examined 405 patients’ charts who were admitted with a diagnosis of acute systolic heart failure or acute on chronic systolic heart failure with a left ventricular ejection fraction ≤ 40%. Twenty-one data elements related to heart failure were abstracted based on Seattle Heart Failure Model. Results: The mean age of the population examined was 77 ± 9 years. The cohort was comprised of 72 % males, mean weight 89 ± 22.5kg, with NYHA class 2.4 ± 0.6 symptoms. Ischemic etiology was identified in 86% with a mean left ventricular EF of 29.8 ± 9 %. The one year all-cause mortality rate was 19.5 %, reflecting an advanced heart failure population. There were 97 (23.9%) patients who were not readmitted in 1 year and were considered as optimal medical therapy. The readmission group was compared against this group (Tables). Up titration of medication or addition happened only in 27 % of patients. In 61.5 % of patients there were no dose adjustments made in follow up visits. There was statistically significant difference (P < 0.05) between both the groups in terms of pharmacology and device therapy. Conclusion: Up titration of heart failure medications to guideline recommended therapeutic doses reduces heart failure readmissions.
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