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4CPS-094 Non-recommended drugs in patients attending an emergency department due to decompensated chronic heart failure
  1. J Ruiz Ramos1,
  2. I Conejo-Marin2,
  3. A Juanes-Borrego1,
  4. CJ Cortés Sánchez3,
  5. L Lopez-Vinardell1,
  6. A Riera-Magallon1,
  7. MA Mangues-Bafalluy1
  1. 1Hospital Santa Creu I Sant Pau, Pharmacy, Barcelona, Spain
  2. 2Hospital de Terrassa, Pharmacy, Barcelona, Spain
  3. 3Hospital Universitario Dr. Peset, Pharmacy, Valencia, Spain


Background and importance Decompensated chronic heart failure (CHF) is one of the main causes of emergency department (ED) visits.

Aim and objectives To assess the frequency of prescription of non-recommended drugs in patients admitted to the ED for decompensated CHF, and its impact on the frequency of 90-day revisits to these units.

Material and methods Retrospective observational study. Patients >18 years diagnosed with CHF who attended the ED of a tertiary hospital due to decompensated episodes were included (December 2020–February 2021).

Potentially inappropriate chronic drugs from the primary care electronic prescription programme according to the review of Page et al 1 were recorded, including those classified with evidence A (assessed in multiple populations) or evidence B (limited populations). To evaluate the impact of these groups of drugs on ED revisits for new decompensated episodes, a multivariate analysis was performed using logistic regression, including those variables related to the patient’s comorbidity with a p value <0.2 in a previous univariate analysis.

Results 135 patients were evaluated: 5 (3.7%) were younger than 65 years, 63 (46.7%) were 65–85 years and 67 (49.6%) were older than 85 years. Regarding left ventricular ejection fraction was <40% in 21 (15.6%) patients, having an unknown value in 41 (30.4%) patients. 121 (89.6%) patients had hypertension, 80 (59.3%) atrial fibrillation, 29 (21.5%) chronic obstructive pulmonary disease, 47 (34.8%) diabetes, 41 (30.4%) ischaemic heart disease and 55 (40.7%) chronic kidney disease (CKD).

75 (54.9%) patients were taking ≥10 drugs at the time of the ED visit. 90 (66.7%) patients were taking beta-blockers, 83 (61.5%) angiotensin-converting enzyme (ACE) inhibitors, 26 (19.3%) potassium-sparing diuretics and 101 (74.8%) loop diuretics. 32 (23.7%) patients were taking potentially inappropriate drugs. 52 (39.7%) patients returned to the ED 90 days after hospital discharge due to new decompensated episodes. In the multivariate analysis, CKD was significantly associated with a higher risk of revisit (OR 3.29, 95% CI 1.43 to 7.55), observing a non-significant increased risk in those patients with non-recommended drugs (OR 2.12, 95% CI 0.85 to 5.34).

Conclusion and relevance The prescription of non-recommended drugs is a frequent phenomenon in patients with CHF who visited the ED with decompensated episodes. Those patients undergoing treatment with these drugs may have a greater risk of 90-day revisits.

References and/or acknowledgements 1. Page RL. Circulation 2016;134:6.

Conflict of interest No conflict of interest

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