| DOI: 10.29090/psa.2024.03.24.2403 | Pharm Sci Asia 2024; 51(3), 259-269 |
Evaluating the Use of Guideline-Recommended Medications and Potentially Inappropriate Medications among Outpatients with Heart FailureKittipak Jenghua1,2*, Sirayut Phatthanasobhon1,2, Duangkamon Poolpun3, Panadda Ngamsom4
1 Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
2
Pharmacoepidemiology, Social and Administrative Pharmacy (PSAP) Research Unit, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand
3
Department of Pharmacy, Buddhachinaraj Hospital, Phitsanulok, Thailand
4
Pharmacy Department, Chiangkham Hospital, Phayao, Thailand.
In heart failure outpatients, it is critical to use guideline-directed medical therapy (GDMT) and avoid potentially inappropriate medications for heart failure (PIMHFs). The study's objective was to investigate GDMT use patterns and rates, as well as PIMHF use prevalence and predictors. Medication prescriptions for HF outpatients between January 1, 2020, and December 31, 2022, were reviewed for GDMT and PIMHF usage. Patterns and rates of GDMT use were determined using current HF recommendations. The prevalence and predictors of PIMHFs, as evaluated by the combined St Vincent, Thai, and Beers criteria, were determined using binary logistic regression analysis and are reported as percentages, adjusted odds ratios (aORs), and 95% confidence intervals (CIs). A total of 541, 242, and 1,110 patients with heart failure and reduced ejection fraction (HFrEF), mildly reduced EF (HFmrEF), and preserved EF (HFpEF), respectively, were included in this study. In HFrEF (31.79%) and HFmrEF (24.38%) patients, triple therapy with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists was most common. However, in HFpEF patients (15.77%), monotherapy with mineralocorticoid receptor antagonists was most common. The overall PIMHF prevalence was 9.03%, with HFpEF (10.72%) having the highest prevalence, followed by HFrEF (7.21%) and HFmrEF (5.37%). The PIMHF predictors were a smaller hospital size (aOR = 1.98, 95% CI = 1.40–2.79), polypharmacy (aOR = 3.15, 95% CI = 1.44–6.90), and hyperpolypharmacy (aOR = 3.80, 95% CI = 2.54–5.68). In clinical practice, HF outpatients may not receive the optimal GDMT pattern. Moreover, PIMHFs are frequently utilized.
Keyword:
Heart failure; Appropriate use of medications; Pattern of medication use; Guideline-recommended medications; Potentially inappropriate medications list
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