An Audit of Inpatient Management of Acute Decompensated Heart Failure With Reduced Ejection Fraction in General Medicine

Abstract

This audit aimed to describe the use of guideline-directed medical therapies (GDMT) in patients with heart failure with reduced ejection fraction who have been hospitalised with decompensated heart failure in a tertiary hospital. Patients not on GDMT due to medical contraindications are termed to be on “rationalised medical therapy” (RMT). The primary objective was to assess the percentage of patients discharged on GDMT, RMT, or suboptimal therapy. Secondary outcomes were the prevalence of sodium-glucose transport protein 2 inhibitors (SGLT2I) use and inpatient venous thromboembolism (VTE) prophylaxis. Patients aged ≥18 years, with a left ventricular ejection fraction of <40% and admitted under General Medicine at Middlemore with an ICD-10 diagnosis of acute decompensated heart failure between 30 September 2021 and 30 March 2022 were identified. Sixty-two patients were randomly selected from an eligible population of 339 patients. Data collection was performed using the Electronic-Prescribing and Electronic Discharge Summary applications. Twenty-seven patients (44%) were discharged on GDMT, 17 (27%) were discharged on RMT, and 18 (29%) were discharged on suboptimal therapy; 8% of patients were discharged on SGLT2I, while 80% did not meet PHARMAC Special Authority criteria. A total of 69% of patients received VTE prophylaxis. Eighteen patients (29%) were on suboptimal heart failure therapy at discharge and almost 31% did not have VTE prophylaxis. This may lead to suboptimal outcomes in mortality and morbidity. A total of 80% of patients could benefit from SGLT2I therapy but did not meet special authority criteria.