Use of Heart Failure-Exacerbating Medications among Heart Failure Patients in a Tertiary Referral Centre in Malaysia

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Background: The American Heart Association (AHA) released a scientific statement consists of list of drugs that may exacerbate heart failure in 2016. Literature review showed the prevalence of the use of heart failure-exacerbating medications is ranging from 25% to 48% among heart failure adults.

Objective: The aim of this study is to evaluate the prevalence of the use of heart failure-exacerbating medications among heart failure admission.

Methods: Data were collected retrospectively from the heart failure admissions between May 2020 and December 2020.

Results: A total of 166 heart failure admissions were examined. Among these admissions, 75.3% of the patients had hypertension, and 52.4% of them had diabetes. The prevalence of using heart failure-exacerbating medications prior to admission was 39.2%, 28.9% during admission and 29.5% upon discharge. Diabetes medication (metformin and metformin XR) was the most common prescribed heart failure-exacerbating medications prior to admission, followed by MDI salbutamol, diltiazem and verapamil. Similarly, the most prescribed heart failure-exacerbating medication at discharge was metformin. However, the prevalence of prescribing both diabetes medication and MDI salbutamol were reduced between admission and discharge where for diabetes medication, the prevalence was reduced from 28.9% to 24.7% and MDI salbutamol was reduced from 7.2% to 4.2%. Patients with diabetes were associated with higher risk of being prescribed with heart failure-exacerbating medications.

Conclusion: More than quarter of patients was prescribed with heart failure exacerbating medication upon discharge. Implementation of safe prescribing practice in heart failure treatment care plan is essential for this group of patients.