4CPS-229 Analysis of clinical pharmacist interventions in the heart failure day hospital

Abstract

HSA prescriptions, duration of treatment, previous serum albumin, previous infection, HSA indication and level of evidence of the indications. The classification was based on the scale established by the American Society of Apheresis, which categorises four groups according to the degree of evidence:. High priority (grade I): paracentesis induced circulatory dysfunction (PICD) after large volume paracentesis (>5 L); hepatorenal syndrome, renal failure after spontaneous bacterial peritonitis (SBP) and plasmapheresis.. Reasonable evidence, but with available alternatives (grade II): resuscitation in critically ill patients with septic shock when crystalloids are insufficient.. Weak evidence (grade III): hypervolaemic hyponatraemia in decompensated cirrhosis, awaiting liver transplantation, non-SBP bacterial infections in cirrhotic patients, prevention of PICD <5 L.. Treatment not recommended (grade IV): other indications. Results The study included 142 patients, 41% women, mean age 66±11 years. The main admission diagnoses were: decompensated cirrhosis (32%), septic shock (31%), haemorrhagic shock (5%) and respiratory infection (4%). They received a total of 223 batches of HSA. The median duration of prescription was 3 days (IQR 2-4). The mean basal plasma albumin was 2.5±0.5 mg/dL. 48% had a previous active infection. The major indications of HSA were: anasarca and hypoalbuminaemia (32%), prevention of PICD >5 L (17%), resuscitation in shock septic (13%) and protein malnutrition (9%). 26% of the indications had grade I evidence, 13% grade II, 9% grade III and 53% grade IV. Conclusion and relevance There is an important use for HSA in hospitals with a low level of evidence. It is necessary to train prescribing doctors to optimise the use of HSA in hospital.