OPTIMAL MEDICAL THERAPY IN CHRONIC HEART FAILURE

Abstract

Objective: The aim of this study was to audit the use of optimal medical therapy
(OMT) in patients with heart failure.

Methodology: This descriptive study was carried out in AFIC-NIHD from April
2011 to February 2012. Seventy consecutive stage D heart failure patients were
included in the study. The patients were assessed clinically by a cardiologist and
all previous documentation, referral letters, prescriptions, and purchase receipts
were reviewed. To identify any other medication patients might have been taking
(which did not appear on the prescriptions) patients were asked to identify
common medicine packs. The patients underwent a detailed clinical evaluation
including history, physical examination. Relevant investigations were done.
AACF/ AHA and ESC Guidelines for the diagnosis and treatment of acute and
chronic heart failure were taken as standard of care.

Results: In our audit we found that a large proportion of patients who were at high
risk as per the Seattle Heart Failure Model (SHFM) were not on OMT, only 12.5%
of the patients were on ß blocker that have been shown to improve mortality in the
large randomised clinical trials. 64.1% were not taking any ß blockers where as
54.7% were not on ACE inhibitors and 53.1% were not receiving any aldosterone
antagonist.

Conclusion: We concluded that a large proportion of patients were not on OMT
despite not having any contraindication to such therapy. This deprives them of
significant survival benefit.