Heart failure is a clinical syndrome that has a major impact on the patients' quality of life and represents a significant economic burden for the healthcare system. Pharmacotherapy that follows European Society of Cardiology’s guidelines is essential for reducing the number of hospitalizations and mortality in patients with heart failure.
The aim of the master's thesis was to study pharmacotherapy changes in patients with heart failure who were hospitalized in the internal medicine department of the General Hospital Murska Sobota in 2020. We analyzed changes in heart failure pharmacotherapy at discharge.
We included 513 patients, who were hospitalized 626 times, in the study. The median age of the patients was 78 years, 55 % were male, and the median number of co-existing diseases was 4. In 126/626 (20 %) hospitalizations, we did not know the left ventricular ejection fraction data, but among the patients who had this data, 232/500 (46 %) had a reduced ejection fraction. Pharmacotherapy changes occurred in 450/626 (72 %) hospitalizations, and only 206/450 (46 %) of the changes were explained in the discharge letter. Beta-adrenergic receptor antagonists were most often introduced, and angiotensin-converting enzyme inhibitors most often discontinued drugs. The proportions of patients with prescribed angiotensin receptor/neprilysin inhibitor, angiotensin-converting enzyme inhibitors, beta-adrenergic receptor antagonists, and mineralocorticoid receptor antagonists increased at discharge, most notably in the population of patients with reduced ejection fraction. In this population, the proportion of patients with prescribed pharmacotherapy in accordance with guidelines increased from 81/232 (35 %) to 124/232 (53 %) patients. Of these, only 32/124 (26 %) reached the target dose. In 9/12 (75 %) hospitalizations with serum potassium levels increased above 5,5 mmol/L, there was a dose reduction below 50 % of the target dose or a discontinuation of mineralocorticoid receptor antagonists. In the case of angiotensin-converting enzyme inhibitors, the same changes occurred in 17/28 (61 %) hospitalizations. Patients who did not reach at least 50 % of the target dose of angiotensin-converting enzyme inhibitors had significantly higher frequency of serum potassium levels greater than 5,5 mmol/L and more comorbidities, in the case of mineralocorticoid receptor antagonists they more often had glomerular filtration rate lower than 30 mL/min/1,73 m2, and in the case of beta-adrenergic receptor antagonists they less often had atrial fibrillation and increased pulse than patients who reached at least 50 % of the target dose.
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