Therapy modifications during hospitalization in patients with chronic heart failure

A tool for assessment of heart failure prescribing quality: A systematic review and meta‐analysis

“…That is why Stork et al and Klimm et al modified the GAI to include target dose and contraindications to therapy. Bosch et al and Deticek et al considered the issue of HF licenced medications as part of guideline adherence. Each of these modifications has increased the complexity of the GAI and enhanced its ability to differentiate from standard DURs.…”

“…The GAI is a flexible measure, and it seems possible that there is scope to further improve GAI scores. Deticek et al and Oertle et al have shown that there is potential for a 10% to 15% improvement by identifying patients where no barriers to prescribing exist. However, an electronic tool such as the IRER may be better placed to review patients in the clinical setting and to maximise patient‐appropriate guideline adherence.…”

“…The characteristics of each included study are shown in Table 1 The studies reported the use of guideline adherence assessment tools in several different health care settings including 8 studies performed in ambulatory care, 18,21,25,27,[30][31][32][33] 6 studies in primary care, 22,24,26,28,32,34 and 7 studies in hospital inpatient settings. 21,23,26,27,29,31,35 Seven studies 18,25,27,[30][31][32]35 included a followup period of 6 to 12 months while two studies 21,23 reported a follow-up period of almost 2 years. Twelve studies were performed in Europe, 6 of which were performed in Germany.…”

“…36 Thirteen of the 16 studies identified used the GAI. 18,21,22,[24][25][26][27][29][30][31][32]34,35 This tool has been modified in several ways since its publication, and only two studies used the original tool. 24,32 Modifications to the GAI include the consideration of contraindications to therapy, 21,22,24,26,27,29,30 recommended target doses, 22,30 general practitioner (GP) rationale, 26,34 and patients' socioeconomic level 26,29 as eligibility criteria for guideline adherence.…”

“…Six studies 22,24,26,30,34,35 reported the frequency of HF patients receiving >50% of the daily target dose of disease-modifying therapy ( Figure 2). Overall, 57% of patients were prescribed >50% of target dose of RASi and 33.2% of patients were prescribed >50% of target dose of beta-blocker.…”