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Mind the Gap: Mismatches Between Clinicians and Patients in Heart Failure Medication Management

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Abstract

Purpose

Previous studies on the ‘treatment gap’ in patients with heart failure (HF) have focused either on prescribing or patients’ adherence to prescribed treatment. This study sought to determine whether or not recent initiatives to close the gap have also minimised any mismatches between physicians’ expectation of their patients’ medications, medications in the patients’ possession and their actual medication use.

Methods

A cross-sectional observational survey was conducted from December 2015 to June 2016 in The Alfred Hospital HF clinic in Melbourne, Australia. Patients were invited to participate if they had chronic HF (NYHA class II to IV), were aged ≥ 60 years, had no history of HF related hospitalisation within the past 6 months and were prescribed at least two HF medications.

Results

Of 123 eligible patients, 102 were recruited into the study. Beta-blockers, mineralocorticoid receptor antagonists, loop diuretics and statins were associated with the highest rates of mismatches of drugs and doses, ranging from 10 to 17%. Discrepancy of total daily doses was the most common type of mismatch. Overall, only 23.5% of the patients were taking the right drugs at the right doses as expected by their cardiologists/HF specialists.

Conclusions

Despite improved prescribers’ adherence to guideline-directed medical therapy, there remain considerable mismatches between prescribers’ expectation of patients’ HF medications, medications in patients’ possession and their actual medication use. Initiatives to improve this situation are urgently needed.

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Acknowledgements

KLC receives a PhD scholarship from the Ministry of Education, Malaysia. CMR is supported by a Research Fellowship from the National Health and Medical Research Council of Australia (NHMRC APP 1045826). The late Professor Henry Krum had made substantial contribution to the study design before he passed away.

Author information

Authors and Affiliations

  1. CCRE Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia

    Ken Lee Chin, Christopher M. Reid, Andrew Tonkin, Ingrid Hopper & Danny Liew

  2. School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia

    Marina Skiba

  3. School of Public Health, Curtin University, Perth, Australia

    Christopher M. Reid

  4. Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, Australia

    Ingrid Hopper & Justin A. Mariani

  5. Central Clinical School, Faculty of Medicine, Monash University, Melbourne, Australia

    Justin A. Mariani

  6. Heart Failure Research Group, Baker Heart and Diabetes Institute, Melbourne, Australia

    Justin A. Mariani

Authors
  1. Ken Lee Chin
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  2. Marina Skiba
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  3. Christopher M. Reid
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  4. Andrew Tonkin
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  5. Ingrid Hopper
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  6. Justin A. Mariani
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  7. Danny Liew
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Corresponding author

Correspondence to Danny Liew.

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Conflict of Interest

All authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Ethical Approval

This study was approved by the Alfred Hospital Ethics Committee (233/15) and Monash University Human Research Ethics Committee (CF15/2335-2015000940).

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

In memoriam of Henry Krum

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Chin, K.L., Skiba, M., Reid, C.M. et al. Mind the Gap: Mismatches Between Clinicians and Patients in Heart Failure Medication Management. Cardiovasc Drugs Ther 32, 37–46 (2018). https://doi.org/10.1007/s10557-017-6768-4

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  • DOI: https://doi.org/10.1007/s10557-017-6768-4

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