Important Heart Drugs Underprescribed by Non-cardiologists

Newswise — Patients with congestive heart failure (CHF) are less likely to be discharged from the hospital with a prescription for an ACE inhibitor and other recommended medications if they are treated by a non-cardiologist, according to a study published January 15 in the American Journal of Health-System Pharmacy. Beta-blockers, ACE inhibitors, and aldosterone antagonists have been shown to significantly decrease morbidity and mortality and are among the medications recommended by the Heart Failure Society of America (HFSA) to treat CHF, which affects nearly 5 million Americans.

Prescribing differences were demonstrated for several key medications, including: - ACE inhibitor (prescribed for 61 percent of patients upon discharge by cardiologists versus only 35 percent by non-cardiologists) - Beta-blocker (prescribed for 65 percent of patients upon discharge by a cardiologist versus only 32 percent by non-cardiologists) - Aldosterone antagonist (prescribed for 17 percent of patients upon discharge by a cardiologist versus only 7 percent by non-cardiologists)

The study also found that cardiologists are more likely to admit a CHF patient to the Intensive Care Unit and order diagnostic tests, including chest x-rays, electrocardiograms, nuclear medicine tests, cardiac catheterizations, and stress tests, without significantly increasing a patient's length of stay.

While the study supports earlier research that suggests that cardiologists are more likely to comply with HFSA prescribing recommendations, it also shows room for improvement even among cardiologists. "Neither cardiologists nor non-cardiologists prescribed ACE inhibitors to all eligible patients as frequently as recommended by HFSA guidelines," said Jean A. Patel, Pharm. D., clinical pharmacist at Northwestern Memorial Hospital and lead author of the study. "Pharmacists in hospitals and health systems are dedicated to improving these numbers." Studies have shown that pharmacist involvement on patient rounds helps improve prescribing choices.

Patel urges patients to ask more questions about their medications. "Today's medications are complex and very powerful. Patients or their family members should ask to speak to the hospital pharmacist whenever they have questions about their medicine," said Patel.

The study, which was conducted at Northwestern Memorial Hospital, was co-authored by Michael A. Fotis, B.S. Pharm, manager of drug information service at Northwestern Memorial Hospital The article may be found online at http://www.ashp.org/ajhp/pdf/1b-R_Patel.pdf. For more than 60 years, ASHP has helped pharmacists who practice in hospitals and health systems improve medication use and enhance patient safety. The Society's 30,000 members include pharmacists and pharmacy technicians who practice in inpatient, outpatient, home-care, and long-term-care settings, as well as pharmacy students. For more information about the wide array of ASHP activities and the many ways in which pharmacists help people make the best use of medicines, visit ASHP's Web site, http://www.ashp.org, or its consumer Web site, http://www.SafeMedication.com.