Improving medication titration in heart failure by embedding a structured medication titration plan

Hickey, Annabel, Suna, Jessica, Marquart, Louise, Denaro, Charles, Javorsky, George, Munns, Andrew, Mudge, Alison and Atherton, John J. (2016) Improving medication titration in heart failure by embedding a structured medication titration plan. International Journal of Cardiology, 224 99-106. doi:10.1016/j.ijcard.2016.09.001

Attached Files (Some files may be inaccessible until you login with your UQ eSpace credentials)
Name Description MIMEType Size Downloads
UQ408486_OA.pdf application/pdf Bytes 0

Author Hickey, Annabel
Suna, Jessica
Marquart, Louise
Denaro, Charles
Javorsky, George
Munns, Andrew
Mudge, Alison
Atherton, John J.
Title Improving medication titration in heart failure by embedding a structured medication titration plan
Journal name International Journal of Cardiology   Check publisher's open access policy
ISSN 1874-1754
0167-5273
Publication date 2016-12-01
Sub-type Article (original research)
DOI 10.1016/j.ijcard.2016.09.001
Open Access Status File (Author Post-print)
Volume 224
Start page 99
End page 106
Total pages 8
Place of publication E Park, Shannon, Clare Ireland
Publisher Elsevier Ireland
Language eng
Abstract To improve up-titration of medications to target dose in heart failure patients by improving communication from hospital to primary care.

This quality improvement project was undertaken within three heart failure disease management (HFDM) services in Queensland, Australia. A structured medication plan was collaboratively designed and implemented in an iterative manner, using methods including awareness raising and education, audit and feedback, integration into existing work practice, and incentive payments. Evaluation was undertaken using sequential audits, and included process measures (use of the titration plan, assignment of responsibility) and outcome measures (proportion of patients achieving target dose) in HFDM service patients with reduced left ventricular ejection fraction.

Comparison of the three patient cohorts (pre-intervention cohort A n=96, intervention cohort B n=95, intervention cohort C n=89) showed increase use of the titration plan, a shift to greater primary care responsibility for titration, and an increase in the proportion of patients achieving target doses of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) (A 37% vs B 48% vs C 55%, p=0.051) and beta-blockers (A 38% vs B 33% vs C 51%, p=0.045). Combining all three cohorts, patients not on target doses when discharged from hospital were more likely to achieve target doses of ACEI/ARB (p<0.0001) and beta blockers (p<0.0001) within six months if they received a medication titration plan.

A medication titration plan was successfully implemented in three HFDM services and improved transitional communication and achievement of target doses of evidence-based therapies within six months of hospital discharge.
Formatted abstract
Background: To improve up-titration of medications to target dose in heart failure patients by improving communication from hospital to primary care.

Methods: This quality improvement project was undertaken within three heart failure disease management (HFDM) services in Queensland, Australia. A structured medication plan was collaboratively designed and implemented in an iterative manner, using methods including awareness raising and education, audit and feedback, integration into existing work practice, and incentive payments. Evaluation was undertaken using sequential audits, and included process measures (use of the titration plan, assignment of responsibility) and outcome measures (proportion of patients achieving target dose) in HFDM service patients with reduced left ventricular ejection fraction.

Results: Comparison of the three patient cohorts (pre-intervention cohort A n = 96, intervention cohort B n = 95, intervention cohort C n = 89) showed increase use of the titration plan, a shift to greater primary care responsibility for titration, and an increase in the proportion of patients achieving target doses of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) (A 37% vs B 48% vs C 55%, p = 0.051) and beta-blockers (A 38% vs B 33% vs C 51%, p = 0.045). Combining all three cohorts, patients not on target doses when discharged from hospital were more likely to achieve target doses of ACEI/ARB (p < 0.0001) and beta blockers (p < 0.0001) within six months if they received a medication titration plan.

Conclusions: A medication titration plan was successfully implemented in three HFDM services and improved transitional communication and achievement of target doses of evidence-based therapies within six months of hospital discharge.
Keyword ACE inhibitor
Beta-blocker
Heart failure
HFrEF
Medication
Titration
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
Admin Only - School of Medicine
School of Medicine Publications
 
Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 0 times in Thomson Reuters Web of Science Article
Scopus Citation Count Cited 0 times in Scopus Article
Google Scholar Search Google Scholar
Created: Tue, 11 Oct 2016, 10:29:43 EST by System User on behalf of Learning and Research Services (UQ Library)