Assessment of optimization of chronic heart failure medications and its effect on readmission rate

• Main Authors: M.D. Khadiga Suliman, Bashier Osman
• Format: Article
• Language: English
• Published: Saudi Heart Association 2018-10-01
• Series: Journal of the Saudi Heart Association
• Online Access: http://www.sciencedirect.com/science/article/pii/S1016731518301507

Introduction: Heart failure is a progressive disease associated with recurrent hospital admissions, although guidelines recommend the use of evidence based medications with optimal doses to reduce readmission rate, but many surveys found that the optimization of heart failure medications in clinical practice is sub optimal. Methodology: Eighty-one patients with heart failure with reduced ejection fraction who were admitted to one of the teaching hospitals in Sudan from March 2016 to May 2016 have been included, optimization of their chronic heart failure medications was assessed and according to that patients have been ordered to three levels of medications optimization, then the readmission rate between the levels was compared by using Kruskal–Wallis test when the comparison was between more than two groups otherwise, Mann-Whitney Test was used, the above 2 tests were used based on Shapiro-Wilk normality test which has shown that readmission rate was continuous skewed data, significant level was set at 0.05, analysis was performed with Statistical Package for Social Sciences (SPSS) software version 23. Results: Five percent of those who prescribed Beta blockers were achieved their target doses, while all the patients who were on Mineralocorticoid receptor antagonists achieved the lower range of their target doses. On the other hand only 3.4% among those who were prescribed Angiotensin Converting Enzyme Inhibitors achieved their target doses. Patients who prescribed all evidence based medications and achieved their target doses were only 4.9% and this group of patients has shown the lowest readmission rate. Conclusion: This study concluded that the dose optimization of recommended heart failure medications was extremely sub optimal and the optimization of medications significantly affects the readmission rate.