Management of Cardiac Failure—Do Practitioners Follow Guidelines?

Abstract

Objective: To assess the use of β-blockers, spironolactone, and the dose of angiotensin-converting enzyme (ACE) inhibitors in patients with congestive cardiac failure. Methods: The medical records of patients discharged with a diagnosis of congestive cardiac failure between January 1, 2001, and June 30, 2001, from the internal medicine and cardiology services at Capital and Coast District Health Board, Wellington, New Zealand, were identified and analyzed for cardiac drugs on admission and discharge. These records were also reviewed for New York Heart Association status and left-ventricular ejection fraction. Results: Two hundred ninety-two patients (146 from each service) were identified as having congestive cardiac failure; 84 were excluded due to death, admission being procedure related, notes being unavailable, or transfers from other services. The patients' mean age was 73 years. Four of 74 eligible patients were started on β-blockers, while 11 of 30 eligible patients were started on spironolactone. Sixteen patients were prescribed spironolactone inappropriately, and 27 were prescribed target recommended doses of ACE inhibitors. Conclusions: This study has shown that guidelines for the treatment of cardiac failure are difficult to follow in clinical practice. Adequate studies in older individuals with congestive cardiac failure are indicated.