The utilization of American Heart Association heart failure guidelines for beta-blocker and angiotensin converting enzyme inhibitor/angiotensin receptor blocker optimization

The American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) clinical guidelines recommend target doses of beta-blockers and angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) in patients with stage C heart failure (HF) and no contraindications.  Because these medications have shown reductions in morbidity and mortality, it is important for providers to be educated on proper use and optimization of pharmacotherapy.  This analysis evaluates the pharmacotherapy of patients in an outpatient clinic.

Objectives: The primary objective is to identify the percentage of patients in this population who are being treated appropriately according to guidelines.  The secondary objectives are to determine why patients are not on optimal therapy and to evaluate other comorbidities present.

Methods: A retrospective chart review is being performed at an internal medicine resident-operated, outpatient clinic.  The patients included had an ICD-9 code indicative of systolic heart failure and were seen from July 2009-July 2010.  Data was collected from patient charts including demographic information, vital signs, drug allergies, smoking habits, medications, laboratory values, and comorbidities.  The data did not include identifiable, protected health information.  Adherence to the 2009 ACCF/AHA updated treatment guidelines for heart failure will be evaluated based on the recorded medications, doses prescribed, and contraindications.  The data will be analyzed using descriptive statistics.  This study has been approved by the Institutional Review Board.

Results: To this point, the total number of patients that have been evaluated is 26, and most patients are not being treated with target doses.  Out of the 22 patients taking beta-blockers identified thus far, none were taking target doses.  Out of the 19 patients taking ACE inhibitors or ARBs identified, five were taking target doses.

Conclusions: From the initial analysis, it is clear pharmacists have an opportunity to contribute positively to the care of heart failure patients.