Evaluation of the prescribing practice of guideline-directed medical therapy among ambulatory chronic heart failure patients.
Evaluation of the prescribing practice of guideline-directed medical therapy among ambulatory chronic heart failure patients.
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DOI：
10.1186/s12872-021-01868-z
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发表时间：
2021-02-18
影响因子：
2.1
通讯作者：
Whitehead D
中科院分区：
文献类型：
--
作者：
Parajuli DR;Shakib S;Eng-Frost J;McKinnon RA;Caughey GE;Whitehead D
研究表明，接受药剂师直接输入作为多学科护理一部分的心力衰竭 (HF) 患者可以获得更好的临床结果。本研究评估/比较了两个多学科诊所之间针对慢性心力衰竭患者的指南指导药物治疗 (GDMT) 处方实践的差异——有或没有药剂师的直接参与。 对 2005 年 3 月至 2017 年 1 月期间到两个多学科门诊就诊的慢性心力衰竭患者进行了回顾性审核；具有综合药剂师护理模式的多学科门诊咨询服务 (MACS) 和普通心脏病心力衰竭服务 (GCHFS) 诊所，无需药剂师的积极参与。 MACS 诊所患者的年龄明显较大（80 岁 vs. 73 岁，p< .001），更有可能是女性（p< .001），并且收缩压（123 vs. 112 mmHg，p< .001）和舒张压（67 vs. 60 mmHg， p < .05) 与 GCHF 诊所患者相比的血压。此外，MACS 诊所的患者表现出更多的多重用药和多种合并症的患病率更高。两家诊所的 GDMT 处方率相似，并且在 HFrEF 中达到了血管紧张素转换酶抑制剂 (ACEIs) 和血管紧张素受体阻滞剂 (ARB) 的最大耐受剂量。然而，MACS 诊所的 HFpEF 患者比 GCHFS 患者更有可能接受 ACEI/ARB 处方（70.5% vs. 56.2%，p = 0.0314）。同时患有 HFrEF 和 HFpEF 的患者（MACS 诊所）服用 β 受体阻滞剂和盐皮质激素受体拮抗剂的可能性显着降低。 MACS 诊所的慢性心房颤动 (AF) 患者中，HFrEF 患者使用地高辛的比例显着较高（82.5% vs. 58.5%，p = 0.004），但出现 AF 时接受抗凝治疗的人数（27.1% vs. 48.0%，p = 0.002）和处方利尿剂的人数（84.0% vs. 0.002）。 94.5%, p = 0.022）在 MACS 诊所就诊的 HFpEF 患者显着较低。年龄、心率、收缩压 (SBP)、贫血、慢性肾功能衰竭和其他合并症是多变量二元 Logistic 回归中使用 GDMT 的主要显着预测因素。研究发现，药剂师参与的多学科团队中某些药物的处方率较低。为了实现最佳实践，有必要仔细考虑人口和临床特征、药物使用禁忌症、多药治疗和潜在的合并症。
Studies have demonstrated that heart failure (HF) patients who receive direct pharmacist input as part of multidisciplinary care have better clinical outcomes. This study evaluated/compared the difference in prescribing practices of guideline-directed medical therapy (GDMT) for chronic HF patients between two multidisciplinary clinics—with and without the direct involvement of a pharmacist. A retrospective audit of chronic HF patients, presenting to two multidisciplinary outpatient clinics between March 2005 and January 2017, was performed; a Multidisciplinary Ambulatory Consulting Service (MACS) with an integrated pharmacist model of care and a General Cardiology Heart Failure Service (GCHFS) clinic, without the active involvement of a pharmacist. MACS clinic patients were significantly older (80 vs. 73 years, p < .001), more likely to be female (p < .001), and had significantly higher systolic (123 vs. 112 mmHg, p < .001) and diastolic (67 vs. 60 mmHg, p < .05) blood pressures compared to the GCHF clinic patients. Moreover, the MACS clinic patients showed more polypharmacy and higher prevalence of multiple comorbidities. Both clinics had similar prescribing rates of GDMT and achieved maximal tolerated doses of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) in HFrEF. However, HFpEF patients in the MACS clinic were significantly more likely to be prescribed ACEIs/ARBs (70.5% vs. 56.2%, p = 0.0314) than the GCHFS patients. Patients with both HFrEF and HFpEF (MACS clinic) were significantly less likely to be prescribed β-blockers and mineralocorticoid receptor antagonists. Use of digoxin in chronic atrial fibrillation (AF) in MACS clinic was significantly higher in HFrEF patients (82.5% vs. 58.5%, p = 0.004), but the number of people anticoagulated in presence of AF (27.1% vs. 48.0%, p = 0.002) and prescribed diuretics (84.0% vs. 94.5%, p = 0.022) were significantly lower in HFpEF patients attending the MACS clinic. Age, heart rate, systolic blood pressure (SBP), anemia, chronic renal failure, and other comorbidities were the main significant predictors of utilization of GDMT in a multivariate binary logistic regression. Lower prescription rates of some medications in the pharmacist-involved multidisciplinary team were found. Careful consideration of demographic and clinical characteristics, contraindications for use of medications, polypharmacy, and underlying comorbidities is necessary to achieve best practice.
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DOI：
10.1016/j.jchf.2017.06.013
发表时间：
2017-11
期刊：
JACC. Heart failure
影响因子：
--
作者：
Hsu JJ;Ziaeian B;Fonarow GC
通讯作者：
Fonarow GC
影响因子：
--
作者：
Fauchier, Laurent;Laborie, Guillaume;Babuty, Dominique
通讯作者：
Babuty, Dominique
影响因子：
18.2
作者：
Chioncel, Ovidiu;Lainscak, Mitja;Filippatos, Gerasimos
通讯作者：
Filippatos, Gerasimos
在心力衰竭和合并症糖尿病或慢性肾脏疾病的患者中使用矿物皮质受体拮抗剂。
影响因子：
5.4
作者：
Cooper LB;Lippmann SJ;Greiner MA;Sharma A;Kelly JP;Fonarow GC;Yancy CW;Heidenreich PA;Hernandez AF
通讯作者：
Hernandez AF
DOI：
10.1161/circheartfailure.112.000003
发表时间：
2013-03
期刊：
Circulation. Heart failure
影响因子：
--
作者：
Bapoje SR;Bahia A;Hokanson JE;Peterson PN;Heidenreich PA;Lindenfeld J;Allen LA;Masoudi FA
通讯作者：
Masoudi FA