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George NE, Shukkoor AA, Joseph N, Palanimuthu R, Kaliappan T, Gopalan R. Implementation of clinical audit to improve adherence to guideline-recommended therapy in acute coronary syndrome. Egypt Heart J 2022; 74:4. [PMID: 35020077 PMCID: PMC8755862 DOI: 10.1186/s43044-021-00237-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite global consensus on the management of acute coronary syndrome (ACS), implementation of strategies to improve adherence of guideline-directed medical therapy (GDMT) remains sub-optimal, especially in developing countries. Thus, we aimed to assess the effect of clinical pharmacist-led clinical audit to improve the compliance of discharge prescriptions in patients admitted with ACS. It is a prospective clinical audit of ACS patients which was carried out for 12 months. The discharge prescriptions were audited by clinical pharmacists for the appropriateness in the usage of statins, dual antiplatelet therapy (DAPT), beta-blockers, and angiotensin-converting enzyme inhibitors (ACE-I)/angiotensin receptor blocker (ARB). A feedback report was presented every month to the cardiologists involved in the patient care, and the trend in the adherence to GDMT was analyzed over 12 months. RESULTS The discharge prescriptions of 1072 ACS patients were audited for the justifiable and non-justifiable omissions of mandated drugs. The first-month audit revealed unreasonable omissions of DAPT, statin, ACE-I/ARB, and beta-blockers in 1%, 0%, 14%, and 11% respectively, which reduced to nil by the end of the 11th month of the audit-feedback program. This improvement remained unchanged until the end of the 12th month. CONCLUSIONS The study revealed that periodic clinical audit significantly improves adherence to GDMT in patients admitted with ACS.
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Affiliation(s)
- Nimmy Elizabeth George
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, India
| | - Aashiq Ahamed Shukkoor
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, India
| | - Noel Joseph
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, India
| | - Ramasamy Palanimuthu
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, India.
| | - Tamilarasu Kaliappan
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, India
| | - Rajendiran Gopalan
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, India
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Shukkoor AA, George NE, Radhakrishnan S, Velusamy S, Kaliappan T, Gopalan R, Anandan P, Palanimuthu R, Balasubramanian VR. Impact of Clinical Audit on Adherence to the Guidelines Directed Medical Therapy in Patients Admitted with Heart Failure. Curr Drug Saf 2021; 15:117-123. [PMID: 32156240 DOI: 10.2174/1574886315666200310114528] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/19/2019] [Accepted: 02/24/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The adoption of guideline recommendations of pharmacotherapy to improve the clinical course of Heart Failure (HF) remains below par. Our objective is to evaluate the impact of clinical audit on adherence to the Guideline-Directed Medical Therapy (GDMT) in patients admitted with acute heart failure with reduced ejection fraction (EF). METHODS A prospective interventional study was conducted over a period of 12 months from June 2018 to May 2019 in all patients admitted with acute heart failure with reduced ejection fraction. The discharge prescriptions of patients who met the inclusion criteria were audited for appropriateness in the usage of neurohormonal blockers and Ivabradine, by a clinical pharmacist on a monthly basis. Audit results were presented to the practicing physicians every month and feedback was given. RESULTS Discharge prescriptions of 716 patients who presented with HF were audited for the reasonable or unreasonable omission of neurohormonal blocking drugs. The first-month audit revealed that the unreasonable omission of Angiotensin-Converting Enzyme Inhibitors/ Angiotensin Receptor Blockers/ Angiotensin Receptor Neprilisin Inhibitors ( ACEI/ARB/ARNI), Betablockers and Mineralocorticoid Receptor Antagonists (MRA) were 24.5%, 13.1%, and 9.09% respectively, which reduced to nil at the end of the study period (p=0.00). Initiation of Ivabradine before prescribing or achieving the target dose of Betablocker was noted in 38.18% of patients in the first month, which was also reduced to nil (p=0.00) at the end of the study. CONCLUSION This study reveals that periodic clinical audit improves adherence to GDMT in patients admitted with heart failure with reduced ejection fraction.
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Affiliation(s)
| | - Nimmy E George
- Department of Cardiology, PSG Hospitals, Tamilnadu, India
| | | | - Sivakumar Velusamy
- Department of Pharmacy Practice, PSG College of Pharmacy, Tamil Nadu, India
| | - Tamilarasu Kaliappan
- Department of Cardiology, PSG Institute of Medical Science and Research, Tamil Nadu, India
| | - Rajendiran Gopalan
- Department of Cardiology, PSG Institute of Medical Science and Research, Tamil Nadu, India
| | - Premkrishna Anandan
- Department of Cardiology, PSG Institute of Medical Science and Research, Tamil Nadu, India
| | - Ramasamy Palanimuthu
- Department of Cardiology, PSG Institute of Medical Science and Research, Tamil Nadu, India
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Shukkoor AA, George NE, Radhakrishnan S, Velusamy S, Gopalan R, Kaliappan T, Anandan P, Palanimuthu R, Balasubramaniam V, Doraiswamy V, Ponnusamy AK. Clinical characteristics and outcomes of patients admitted with acute heart failure: insights from a single-center heart failure registry in South India. Egypt Heart J 2021; 73:38. [PMID: 33932180 PMCID: PMC8088418 DOI: 10.1186/s43044-021-00161-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The epidemiology of HF in India is largely unexplored. Current resources are based on a few hospital-based and a community-based registry from North India. Thus, we present the data from a single hospital-based registry in South India. Patients admitted with acute heart failure over a period of 1 year were enrolled in the registry and were characterized based on their ejection fraction (EF) measured by echocardiogram. The clinical profile of the patients was assessed, including their in-hospital outcomes. One-way ANOVA and univariate analysis were performed for comparison between three EF-based groups and for the assessment of in-hospital outcomes. RESULTS A total of 449 patients were enrolled in the registry, of which 296, 90, and 63 patients were categorized as, HFrEF, HFmrEF, and HFpEF, respectively. The prevalence of HFrEF was higher (65.99%). The mean age (SD) of the study cohort was 59.9±13.3. The majority of the patients presented with acute denovo HF (67%) and were more likely to be males (65.9%). The majority of patients presented with warm and wet clinical phenotype (86.4%). In hospital mortality was higher in HFmrEF (3.3%). CONCLUSION Patients with HFrEF had high adherence to guideline-directed medical therapy (GDMT). HFrEF patients were also likely to have longer hospital stay along with a worsening of renal function. The in-hospital mortality was comparable between the EF-based groups. Additionally, the association of clinical phenotypes with outcome highlighted that patients in warm and wet phenotype had a longer length of hospital stay, whereas the mortality and worsening renal function rates were found to be significantly higher in the cold and wet group.
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Affiliation(s)
- Aashiq Ahamed Shukkoor
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamilnadu, India
| | - Nimmy Elizabeth George
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamilnadu, India
| | | | - Sivakumar Velusamy
- Department of Pharmacy Practice, PSG College of Pharmacy, Coimbatore, Tamilnadu, India
| | - Rajendiran Gopalan
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamilnadu, India
| | - Tamilarasu Kaliappan
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamilnadu, India
| | - Premkrishna Anandan
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamilnadu, India
| | - Ramasamy Palanimuthu
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamilnadu, India
| | - Vidhyakar Balasubramaniam
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamilnadu, India
| | - Vinoth Doraiswamy
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamilnadu, India
| | - Arun Kaushik Ponnusamy
- Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamilnadu, India
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Sundaram S, Kaliappan T, Gopalan R, Palanimuthu R, Anandhan P, Joseph RM. Mechanism and Immediate Outcome of Significant Mitral Regurgitation Following Balloon Mitral Valvuloplasty with JOMIVA Balloon. J Clin Diagn Res 2017; 11:OC01-OC04. [PMID: 28511424 DOI: 10.7860/jcdr/2017/24202.9333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/09/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Balloon Mitral Valvuloplasty (BMV) with inoue balloon is the most common technique being followed worldwide. Over the wire BMV is a modified technique with Joseph Mitral Valvuloplasty (JOMIVA) balloon and is being followed in certain centres. We hypothesized that, the incidence and mechanism of Mitral Regurgitation (MR) is likely to be different from that of inoue balloon. AIM To assess the mechanism and immediate clinical outcome of significant MR following BMV with JOMIVA balloon retrospectively. MATERIALS AND METHODS We retrospectively analyzed the outcome of 48 patients who developed moderate to severe MR out of 249 patients who underwent BMV in our institute. We analyzed the echocardiographic and clinical parameters of these patients. RESULTS Nineteen (7.6%) patients developed severe MR and 29 (11.2%) patients developed moderate MR. Commisural separation resulting in MR was the most common cause which was contributing to 73.6 % and 85.7% of patients with moderate and severe MR respectively. Leaflet tear was the second most common cause which contributed to 15.7% and 14.2% of patients with severe and moderate MR respectively. Chordal rupture contributed to 10.5% of patients with severe MR. Six (31.6%) patients with severe MR developed worsening breathlessness among them one had to be referred for mitral valve replacement during index hospitalization and the rest could be managed medically. Patients with moderate MR remained asymptomatic and stable. CONCLUSION Severe MR following JOMIVA BMV results most commonly due to wide separation of commisures. JOMIVA balloon is less likely to cause damage to subvalvular structures than inoue balloon. Most patients who develop severe MR will not require emergency mitral valve replacement. Moderate MR is well tolerated clinically.
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Affiliation(s)
- Shanmuga Sundaram
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Tamilarasu Kaliappan
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Rajendiran Gopalan
- Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Ramasamy Palanimuthu
- Associate Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Premkrishna Anandhan
- Assistant Professor, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Rinku Mary Joseph
- Clinical Pharmacist, Department of Cardiology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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