Prescribing and up-titration in recently hospitalized heart failure patients attending a disease management program

Carroll, Robert, Mudge, Alison, Suna, Jessica, Denaro, Charles and Atherton, John (2016) Prescribing and up-titration in recently hospitalized heart failure patients attending a disease management program. International Journal of Cardiology, 216 121-127. doi:10.1016/j.ijcard.2016.04.084


Author Carroll, Robert
Mudge, Alison
Suna, Jessica
Denaro, Charles
Atherton, John
Title Prescribing and up-titration in recently hospitalized heart failure patients attending a disease management program
Journal name International Journal of Cardiology   Check publisher's open access policy
ISSN 1874-1754
0167-5273
Publication date 2016-08-01
Year available 2016
Sub-type Article (original research)
DOI 10.1016/j.ijcard.2016.04.084
Open Access Status Not Open Access
Volume 216
Start page 121
End page 127
Total pages 7
Place of publication Shannon, Clare Ireland
Publisher Elsevier Ireland
Collection year 2017
Language eng
Formatted abstract
Background

Heart failure (HF) medications improve clinical outcomes, with optimal doses defined in clinical trials. Patient, provider and system barriers may limit achievement of optimal doses in real life settings, although disease management programs (HF-DMPs) can facilitate up-titration.

Methods and results

Secondary analysis of a prospective cohort of 216 participants recently hospitalized with systolic HF, attending 5 HF-DMPs in Queensland, Australia. Medication history at baseline (6 weeks after discharge) and 6 months provided data to describe prescription rates, dosage and optimal titration of HF medications, and associations with patient and system factors were explored. At baseline, 94% were on an angiotensin converting enzyme inhibitor/angiotensin II receptor blocker (ACEI/ARB), 94% on a beta-blocker (BB) and 42% on a mineralocorticoid receptor antagonist (MRA). The proportion of participants on optimal doses of ACEI/ARB increased from 38% (baseline) to 52% (6 months, p = 0.001) and on optimal BB dose from 23% to 49% (p < 0.001). Significant barriers to ACEI/ARB up-titration were body mass index (BMI) < 25, female gender, polypharmacy, previously diagnosed HF, and tertiary hospital. Significant barriers for BB up-titration were BMI < 25, previously diagnosed HF and non-cardiologist care.

Conclusions

Effective up-titration in HF DMPs is influenced by patient, disease and service factors. Better understanding of barriers to effective up-titration in women, normal weight, and established HF patients may help provide targeted strategies for improving outcomes in these groups.
Keyword Heart failure
Uptitration
Disease management program
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
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