Identification and Follow up of Prescribed Medications that Potentially Exacerbate Heart Failure: A Quality Improvement Project

ConclusionsMedication regimes are complex yet careful review of non- HF medications and frequency of use is critical to ensuring HF success. Strategies to promote medication review with early identification of potential medications that can exacerbate HF and facilitate communication with prescribing providers are necessary. Since implementation of this intervention we have expanded education among the nursing staff to promote awareness and have included pharmacy and nursing students into the medication review process to identify medications associated with HF exacerbation.ResultsA total of 86 HF patients’ records were reviewed with 44 HF patients followed during the process change. Patients were 77 (SD + 7.9) years of age, 57% male, 53.5% HFpEF and 18.6% improved (LVEF of 40-50%). Patients were on a median of 16 medications including PRNs (range 6-47). Prior process change medications associated with a HF exacerbation were prescribed in 64% (27) of the patients with 28.5% (12) having one medication and 35.7% (15) two or more. Of the medications prescribed 9 were identified as having a potential for a major magnitude of effect and 13 major to moderate effect. During the process change 43.2% (19) patient had medications prescribed associated with a HF exacerbation with 36.3% (16) having one medication and 7% (3) two or more. Two medications were identified as having a major magnitude of effect and 11 major to moderate HF effect. The most frequent medications prescribe...
Source: Heart and Lung: The Journal of Acute and Critical Care - Category: Respiratory Medicine Source Type: research

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Publication date: Available online 17 November 2019Source: Pharmacological ResearchAuthor(s): Qiujin Jia, Lirong Wang, Xiaonan Zhang, Yuejia Ding, Hao Li, Yingxi Yang, Ao Zhang, Yanyang Li, Shichao Lv, Junping ZhangAbstractIn recent years, although the concept and means of modern treatment of chronic heart failure(CHF) are continually improving, the readmission rate and mortality rate are still high. At present, there is evidence that there is a link between gut microbiota and heart failure, so the intervention of gut microbiota and its metabolites is expected to become a potential new therapeutic target in heart failure. ...
Source: Pharmacological Research - Category: Drugs & Pharmacology Source Type: research
A new look at an old study helps clarify some of the mystery on the safe use of digoxin in heart failure.European Heart Journal
Source: Medscape Today Headlines - Category: Consumer Health News Tags: Cardiology Journal Article Source Type: news
AbstractPulmonary hypertension (PH) is a complex and progressive disease characterized by increased pulmonary vascular resistance and pulmonary artery pressure, leading to pulmonary vascular remodeling, right heart failure, and ultimately death. Although several molecular pathways related to vascular remodeling have been reported, the mechanism behind this fatal disease with poor prognosis remains largely unclear. Long noncoding RNAs (lncRNAs) have been proven to be playing crucial roles in various biological processes, and emerging studies demonstrated lncRNAs as essential epigenetic modifiers involved in the onset and de...
Source: Heart Failure Reviews - Category: Cardiology Source Type: research
AbstractPurpose of ReviewTo provide insight into the role of urine biomarkers and electrolytes for the management of heart failure.Recent FindingsThe age-dependent decrease in glomerular filtration rate due to loss of functional nephrons occurs at a faster pace in heart failure, potentially exacerbated by episodes of acute kidney injury. Urine biomarkers have not convincingly demonstrated to improve detection of irreversible renal damage and predict long-term renal trajectories, compared with serial creatinine measurements. Recent data show that natriuresis and diuretic response track poorly with glomerular filtration, but...
Source: Current Heart Failure Reports - Category: Cardiology Source Type: research
A translational rat model of chronic heart failure was employed to examine the cardioprotective effect of fabomotizole hydrochloride. Fabomotizole therapy for 28 days (15 mg/kg/day intraperitoneally) restored inotropic function of the left ventricle and increased ejection fraction from 54 ±3 to 65±3% (p=0.001). The inotropic function returned to normal against the background of significantly reduced myocardial expression of angiotensin (p=0.01) and glucocorticoid (p=0.03) receptors and significant increased expression of sigma-1 receptors (p=0.04). Inhibition of abnormal expression of angiotensin and glucocor...
Source: Bulletin of Experimental Biology and Medicine - Category: Biology Source Type: research
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Source: Current Cardiovascular Risk Reports - Category: Cardiology Source Type: research
AbstractPurpose of ReviewExplore controversial biomarker-guided management of patients with heart failure (HF) with reduced ejection fraction.Recent FindingsNatriuretic peptides (e.g., BNP, NT-proBNP) are elevated in HF as a result of end-diastolic stress and are used in the diagnosis and prognosis of heart failure. Natriuretic peptide levels decrease with guideline-directed medical therapy (GDMT). Multiple small studies examined whether the use of biomarker-guided therapy would be beneficial to guide HF care and potentially improve outcomes. Guiding Evidence-Based Therapy Using Biomarker Intensified Treatment in Heart Fai...
Source: Current Heart Failure Reports - Category: Cardiology Source Type: research
AbstractPurpose of ReviewDecision-making in advanced heart failure (HF) is a complex process that involves careful consideration of competing tradeoffs of risks and benefits in regard to heart transplantation (HT) or left ventricular assist device (LVAD) placement. The purpose of this review is to discuss how biomarkers may affect decision-making for HT or LVAD implantation.Recent FindingsN-Terminal probrain natriuretic peptide, soluble suppression of tumorigenicity-2, galectin-3, copeptin, and troponin T levels are associated with HF survival and can help identify the appropriate timing for advanced HF therapies. Patients...
Source: Current Heart Failure Reports - Category: Cardiology Source Type: research
AbstractPurposeAtrial fibrillation is the most common sustained arrhythmia, with a prevalence of 1 –2% in the general population and over 15% in people older than 80 years. Due to aging of the population it imposes an increasing burden on the healthcare system because of the need for life-long pharmacological treatment and the associated increased risk of heart failure and hospitalization. Hen ce, identification of the factors that predispose to atrial fibrillation it is of utmost relevance.Recent FindingsSeveral conditions exist that are characterized by inappropriately high levels of aldosterone, mostly primar...
Source: Current Hypertension Reports - Category: Primary Care Source Type: research
ConclusionThe findings from this study have established the need to improve current education and rehabilitation programmes for patients with CHF by addressing those factors significantly influencing their adherence to diet and medication.
Source: Heart and Lung: The Journal of Acute and Critical Care - Category: Respiratory Medicine Source Type: research
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