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Failing Heart Failure Patients

Australian teaching hospitals may be putting heart failure patients at further risk through a reluctance to prescribe them life-saving cardiovascular drugs.//

A recent study, published in the latest edition of the Medical Journal of Australia, evaluated the use of cardiovascular medications in patients with and without heart failure after a myocardial infarction (MI), otherwise known as a heart attack.

“Heart failure is a common and potentially lethal complication of MI, conferring a four-to-fivefold increase in mortality,” says Professor Henry Krum, co-author of the study and head of the NHMRC Centre of Clinical Research Excellence in Therapeutics at Monash University in Melbourne.

He says cardiovascular medication reduces the risk of disease and death in affected patients, but it is not known whether evidence-based prescribing occurs in Australian teaching hospitals.

Of the 479 patients admitted for MI who participated in the study, 116 had heart failure at some point during their hospitalisation.

But the MI patients were significantly less likely to be prescribed some types of cardiovascular medication than patients without heart failure.

Prof Krum says recent analyses have confirmed that some MI patients do derive substantial benefit from proven heart failure therapies, and their use should therefore be encouraged.

However he noted that the low prescribing rates may be explained by concerns over low blood pressure and greater clinical instability in patients with heart failure.

“In managing patients with heart failure, … the net benefit of multiple agents has to be weighed against the risks and the possibility of adverse events and drug interactions,” says Prof Krum.

“Patients with heart failure receive fewer life-saving drug therapies compared with those who do not have heart failure. These deficiencies in prescribing may lead to substantial increases in [cardiovascular] events in these patients.

“Given the absolute benefit of drug therapy in patients with heart failure after MI, our findings suggests the potential for suboptimal prescribing [exists] in Australian teaching hospital pracice.”

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