Abstract
Objectives: To obtain local data on the reasons why hospitalised heart failure patients are not being given a combination of beta-blockers (BB) and Angiotensin Converting Enzyme inhibitors (ACE –I). Method: A survey was carried out of the heart failure patients discharged in the year 2012 from Sheffield Teaching Hospitals and reported to the National Heart Failure Audit who was not on ACE-I or BB. The main measures were the reasons for not giving those agents, and the use of alternative medications. Results: The total number of our heart failure patients who were reported to the National Heart Failure Audit in 2012, and who were not on ACE-I or BB was 96 patients. Of these, 38 patients (40%) had heart failure with preserved ejection fraction (HFPEF), and 58 patients (60%) had left ventricular systolic dysfunction (LVSD). Of the 58 patients with HF-LVSD, 25 patients did not have contraindications to either ACE-I or BB. However, 2 of them were on end of life care pathway (EOLCP) and thus were appropriately managed, this leaves 23/98 (23.5%) of overall patients managed inappropriately. Contraindications to or adverse effects from ACE-I or BB were encountered in 35/58 and 15/58 of the patients, respectively. Conclusion: HFPEF is the main reason for not using BB and ACE-I in heart failure patients, followed by contraindications to these agents. ACE inhibitors had higher rate of adverse effects than beta blockers.
Highlights
The morbidity and mortality rates of patients with heart failure have progressively fallen through the cumulative effects of several classes of agents including angiotensin converting enzyme inhibitors (ACE-I), beta-blockers (BB), aldosterone antagonists, combined arterial and venous dilators and angiotensin receptor blockers (ARB) [1]
The evidence supports the use of both angiotensin-converting enzyme (ACE) inhibitors and beta-blockers licensed for heart failure to all patients with heart failure due to left ventricular systolic dysfunction as a first line treatment [5,6,7,8,9,10]
A retrospective study was performed on the cohort group of heart failure patients who were discharged in the year 2012 from our institution with heart failure and were reported to the National Heart Failure Audit, but were not on ACE inhibitors and beta-blockers
Summary
The morbidity and mortality rates of patients with heart failure have progressively fallen through the cumulative effects of several classes of agents including angiotensin converting enzyme inhibitors (ACE-I), beta-blockers (BB), aldosterone antagonists (mineralocorticoid receptor antagonists, MRA), combined arterial and venous dilators (combined hydralazine and nitrates, Hyd+N) and angiotensin receptor blockers (ARB) [1]. These advances have been achieved in the treatment of heart failure associated with reduced left ventricular ejection fraction or HF with LVSD, which comprises almost 50% of the heart failure patient population in the community and around 65-70% of hospitalised heart failure patients. We posed the question as to whether there were good reasons for not using ACE inhibitors and beta-blockers in some of the patients with heart failure, to explain the plateau that we seem to have reached
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