Adherence to treatment guidelines in the pharmacological management of chronic heart failure in an Australian population

Abstract

BackgroundTo document the pharmacotherapy of chronic heart failure (CHF) and to evaluate the adherence to treatment guidelines in Australian population.MethodsThe pharmacological management of 677 patients (female 46.7%, 75.5 ± 11.6 years) with CHF was retrospectively analyzed.ResultsThe use of angiotensin converting enzyme (ACE) inhibitors/angiotensin receptor blockers (ARB) and β-blockers were 58.2 % and 34.7 %, respectively. Major reasons for non-use of ACE inhibitors/ARBs were hyperkalemia and elevated serum creatinine level. For patients who did not receive β-blockers, asthma and chronic obstructive pulmonary disease were the main contraindications. Treatment at or above target dosages for ACE inhibitors/ARBs and β-blockers was low for each medication (40.3% and 28.9%, respectively).ConclusionsEvidenced-based medical therapies for heart failure were under used in a rural patient population. Further studies are required to develop processes to improve the optimal use of heart failure medications.

Physician-adherence to pharmacotherapy guidelines for chronic heart failure in a tertiary health facility in Lagos, Nigeria

“…With our reported good adherence to ACEI/ARB, such patients would be eligible for additional BB and AA therapy [1,2,7,8] , although our data uncovered serious under-prescription of BB and AA classes. Consistently, wide variations in adherence have been reported for beta adrenergic blockers in CHF in other studies [12,15,[17][18][19][20] . In our study, adherence to BB (48%) was surprisingly higher than 34% reported for rural Australia, but much lower than 57.8% in Japan [14] and 84% for both USA [12] , and South Africa [20] .…”

“…Thus, with regard to specific classes, the present study demonstrated a good physician -adherence of 83% for ACEI/ARB, which is comparable to those of South Africa, Europe and USA [12,15,17,20] . Interestingly, ours was higher than the ACEI/ARB adherence noted in Japan [14] , and rural Australia [19] . Other authors have suggested that class of physicians or seniority of physicians may influence level of knowledge and adherence [14][15][16] .…”

“…The last decade has witnessed keen interest in CHF physician-adherence, resulting in several publications from Europe [15] , USA [12,17,23] , Japan [14] , Pakistan [18] , Australia [19] and South Africa [20] . These international studies have highlighted several differences in degree of adherence, and perceived barriers to adherence [17] .…”

“…Generally guidelines have been known to influence quality of care, and have been used as a performance measure for health facilities [12,16,17] . Globally, in recent times, multiple publications on physician-adherence to CHF guidelines attest to its growing importance [11,12,14,15,[18][19][20] . Such studies have consistently uncovered variations and potential disparities in the care of heart failure patients [11,12,14,15,[17][18][19][20] .…”

“…Globally, in recent times, multiple publications on physician-adherence to CHF guidelines attest to its growing importance [11,12,14,15,[18][19][20] . Such studies have consistently uncovered variations and potential disparities in the care of heart failure patients [11,12,14,15,[17][18][19][20] . Treatment of CHF is influenced by the patients' and physicians' gender with regard to evidence-based drugs and their dosage; with implications for gender-related treatment imbalance [24] .…”