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Suntheep Batra, M.Pharm Department of Pharmaceutical Care Faculty of Pharmacy, Payap University

Clinical Impact of Adherence to Pharmacotherapeutic Guidelines on the Outcome in Patients with Chronic Heart Failure. Suntheep Batra, M.Pharm Department of Pharmaceutical Care Faculty of Pharmacy, Payap University Chiang Mai, Thailand. Background.

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Suntheep Batra, M.Pharm Department of Pharmaceutical Care Faculty of Pharmacy, Payap University

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  1. Clinical Impact of Adherence to Pharmacotherapeutic Guidelines on the Outcome in Patients with Chronic Heart Failure Suntheep Batra, M.Pharm Department of Pharmaceutical Care Faculty of Pharmacy, Payap University Chiang Mai, Thailand

  2. Background • ACEIs, ARBs, AAs and BBs havebeen shown to improve hospitalization and survival, and were recommended in several CHF guidelines • However, many patients still received suboptimal prescription of recommended medications • The impact of guidelines adherence on clinical outcomes in CHF patients has never been evaluated in Thailand

  3. Objectives • Toevaluate guidelines adherence in CHF patients • To investigate the impact of adherence to CHF guidelines on the rate of cardiac events(composite endpoint of CHF hospitalization or cardiovascular death)

  4. Methods • Study design • Retrospective cohort observational study • Patients • 331 patients who were admitted to Nakornping Hospital between October 2005 and December 2007 for HF exacerbationwere enrolled and followed-up until June 30, 2009

  5. Methods (Cont’) • Assessment of Guidelines Adherence • Guideline adherence indicator (GAI-3) were calculated after hospital discharge for at least 3 months based on recommendation ofACC/AHA 2005, ESC 2005, and HAT 2008 guidelines • Patients were categorized to three adherence groups according to GAI-3 • Low adherence: 0-33% • Medium adherence: 50-66% • High adherence: 100%

  6. Low adherence: GAI-3 = 0-33% Medium adherence: GAI-3 = 50-67% High adherence: GAI-3 = 100% Methods (Cont’) • Assessment of Guidelines Adherence (Cont’) • Calculation of GAI-3 ACEIs/ARBs Beta-blockers Aldosterone- antagonists GAI-3 (%) NYHA II YES YES - 2×50 NYHA III/IV YES YES YES 3×33.3

  7. Results • Adherence rates of recommended drug regimens

  8. Results (Cont’) • Cardiac events among 3 adherence groups *Log-rank test was used to test differences between the three adherence groups

  9. Results (Cont’) • Multivariate predictors of cardiac events *Adjusted with age, NYHA class, hypertension, coronary heart disease, chronic kidney disease, diabetes mellitus, prescription of recommended drugs and dosage of ACEIs/ARBs and beta-blockers †Cox-proportional hazards regression analysis

  10. Results (Cont’) Kaplan–Meier curve for multivariate analysis High GAI-3 Medium GAI-3 Low GAI-3

  11. Conclusion • Adherence to pharmacotherapeutic guidelines for CHF was a significant predictor of fewer cardiac eventsin clinical practice in Thailand

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