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