Prescribed heart failure pharmacotherapy: How closely do GPs adhere to treatment guidelines?

Abstract

Heart failure patients need GPs to adhere to treatment guidelines to improve health outcomes. To examine the extent to which pharmacotherapy of heart failure patients referred for a Home Medicines Review (HMR) adheres to heart failure management guidelines. This retrospective study examined HMR reports of patients with heart failure, who were referred for a HMR due to polypharmacy. Analysis established current pharmacotherapy patients were taking and whether it aligned with heart failure guidelines. Further analysis established the types of recommendations made to the referring GPs, in order to optimise heart failure pharmacotherapy. There were 258 patients referred for HMRs between 2015 and 2018; 30 patients had a diagnosis of heart failure and therefore included in the analysis. Out of these, 13 patients were not on an ACEI and 23 were not on an AR2B; seven patients were neither on ACEI nor AR2B. The pharmacist recommended commencing ACEI in 4 patients and an AR2B in 2 patients. Nine patients were not on any B-blocker, and 4 patients were recommended to commence a B-blocker. Most patients were on suboptimal doses of their heart failure medicines, for which dose up-titrations were recommended. There was a recommendation to assess 6 patients for symptoms indicative of heart failure exacerbation, e.g. SOB. Heart failure pharmacotherapy in patients referred for HMRs was not optimised. Pharmacists play a crucial role in optimising the treatment of heart failure, and in prompting GPs to align pharmacotherapy with treatment guidelines.