Utilization of Beta-Blockers and Diuretics in Treating Heart Failure Patients in Sultan Qaboos University Hospital

Al-Salt Al-Kharusi,Ali Abdulrahman,Tariq Dhiyab Al-Saadi

doi:10.24018/ejmed.2020.2.2.234

Abstract

Background: Heart failure (HF) is the inability of the heart to pump blood to meet tissue requirement of oxygen and nutrition, due to abnormality in cardiac structure or function. The mortality from congestive heart failure remain increasing along with aging of the population. In Oman, the prevalence of HF is 5.17 per 1000 people and with male and older age group domination. Beta-blockers and diuretics are well known drugs that decrease mortality and morbidity. According to heart failure treating guidelines beta-blockers are the first line treatment for HF. Since HF has a high prevalence, this study aim was to determine the utilization of beta-blockers and diuretics in treating heart failure patients in Sultan Qaboos University Hospital (SQUH). Methods: A retrospective cross-sectional conducted in SQUH, in cardiology day care clinic in the period from 1st of June until 30th of August. This study included all Omani patients with 120 out of 778 patients were included who were above 18 years old, diagnosed with HF, receiving at least one HF medication from SQUH pharmacy, and did not have any missing data. Hospital electronic medical record was used to obtain patients data and parameters. Results: Out of 120 patients, 54.2% were males and 45.8% were females, with mean age equal to 64 ± 13 years and mean EF equal to 37 ± 14.5 %. Diuretics were taken by 95% of the patients, where beta-blockers were taken by 81.6%. Prescription of beta-blockers was significantly decreased by increase in the age of the patients (p =0.024), while diuretics do not show any significant with change in the age. Both beta-blockers and diuretics do not show any significant increase or decrease in prescription with change in the EF. Bisoprolol was not affected by increase in age or EF. The prescription of carvedilol was significantly affected with increase the age (p = 0.006), however it was not affected by increase the EF. The prescription of spironolactone was significantly affected by increase the age (P= 0.001) and by increase the EF (P = 0.001). Conclusion: Carvedilol and furosemide were the most prescribed drugs in SQUH for treating HF patients. All the mean daily doses of the drugs mentioned in this study followed the newer 2016 European Society of Cardiology Guidelines for the diagnosis and treatment of acute and chronic HF.

Highlights

By studying the percentage of utilization of beta-blockers medications among heart failure patients in Sultan Qaboos University Hospital (SQUH), we found that 81.6% of our patients were on betablockers. 62.2% were on carvedilol and 37.8% were on bisoprolol
The utilization of beta-blockers medication decreased significantly with increase in the age of the heart failure patients, some studies showed that beta-blockers are effective in treating the older heart failure patients which disagree with our finding but the comorbidities that our patients have and the ability of our patients to tolerate the drugs may lead to decrease the utilization of beta-blockers drugs
These results showed that SQUH pharmacy follows the 2016 European Society of Cardiology Guidelines for the diagnosis and treatment of acute and chronic heart failure which stated that the starting dose is 1.25 and the target dose is 10 mg, and most of our patient were on 2.5 and 5 mg/day possibly because they could not tolerate the higher doses or because their heart failure worsen with higher doses (BNF, 2015)

Summary

Introduction

(corresponding email: t.dhiyab @hotmail.com ) Al-Salt Al-Kharusi, Sultan Qaboos University, Oman. Due to abnormality in cardiac structure or function (Dickstein et al, 2010) It can be defined as a syndrome characterized by typical symptoms such as fatigue, swelling, and breathless, and typical signs such as raised jugular venous pressure, displaced apex beat. The result of these symptoms and signs is abnormality in cardiac structure and function (McMurray et al, 2012). Hypertension and ischemic heart disease (IDH) are the most well-known predisposing factors for HF (Al-Shamiri, 2013).

Methods

Discussion

Conclusion