Abstract
Introduction
Heart failure with reduced ejection fraction (HFrEF) remains an important topic within geriatric populations due to its high prevalence. The European Society of Cardiology (ESC) recommends the four pillars, namely ARNI/ACE inhibitors/ARB, beta-blockers, mineralocorticoid receptor antagonists (MRA) and SGLT2 inhibitors. Frailty and co-morbidities often complicates management, yet the benefit is substantial, with an estimated 73% relative risk reduction in mortality. This project evaluated compliance to the four pillars on hospital discharge, following interventions including teaching sessions and circulation of posters via email.
Methods
The project was conducted in the Geriatric Department in the Freeman Hospital, aiming to optimise the management of HFrEF during admission. Discharge summaries were analysed as a communication tool to the wider MDT. Patients discharged over a one-month period, with new or existing HFrEF, were included in each cycle. Discharge medications were analysed against the four pillars, with further review of reasons for omission.
Results
Among 291 discharges, 8.56% fulfilled the criteria for the project. Following interventions, a significant improvement was observed in the compliance to most medication classes, with a one-fold increase in MRA and 16.9% absolute increase in SGLT-2. Beta-blockers remained most widely accepted (84.0%), even when used as monotherapy. Notably, the percentage of patients on all four pillars increased from 0% in the first cycle to 16.0% in the second. However, significant gaps were identified in that 12.0% of patients received none of the pillars, without reasons of omission documented, potentially compromising patient care.
Conclusion
Overall, this project demonstrated a significant improvement over two cycles in the compliance to guideline-recommended four pillars of HFrEF. Nevertheless, 12% were not prescribed any of the four pillars, with no recorded rationale. Future efforts should focus on active consideration of the four pillars during hospitalisation, and ensure that omissions are clearly justified and communicated in discharge summaries.