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dc.contributor.advisorWung, Shu-Fenen_US
dc.contributor.authorAkalu, Masresha*
dc.creatorAkalu, Masreshaen_US
dc.date.accessioned2015-03-24T19:25:46Z
dc.date.available2015-03-24T19:25:46Z
dc.date.issued2014
dc.identifier.urihttp://hdl.handle.net/10150/347052
dc.description.abstractBackground: Heart failure (HF) is a major public health problem in the United States and accounts for a large burden in rising health care expenditures. Appropriate use of evidence-based pharmacological treatment, including the use of renin-angiotensin-aldosterone inhibitors and beta-blockers can slow progression of the disease and reduce the need for hospitalization. Objectives: In a sample of individuals with HF in a primary care setting, the objectives of this study were to determine the level of providers' adherence to evidence-based pharmacological guidelines and the rate of cardiovascular-related emergency department or hospital visits. Methods: A convenience sample of patients 18 years of age and older with a diagnosis of HF was included. A retrospective chart review of 54 HF subjects was done between April and September 2014, using the American College of Cardiology Foundation and American Heart Association outpatient performance measurement set for HF. Results: Adherence to guideline recommendations for beta-blocker, angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker ARB), anticoagulation for atrial fibrillation, statin, and aldosterone receptor antagonist therapy was present in 81%, 77.8%, 78%, 80.7% and 23.1% of eligible subjects, respectively. The use of ACEIs/ARBs (OR=8.853, CI 1.212-64.66, p= 0.032) and beta-blockers (OR= 9.24, CI 1.212-70.438, p =0.031) was significantly associated with reduced number of (<1) cardiovascular-related emergency department or hospital visits after adjusted for confounders including age, sex, body mass index, and comorbidities. Conclusion: The use of ACEIs/ARBs and beta-blockers among primary care providers was comparable or higher than similar studies conducted in the primary care settings. However, despite the available evidence and recommendations, the use of aldosterone receptor antagonists in HF patients with myocardial infarction and diabetes mellitus was still low in the absence of any contraindications. These findings can be used by primary care providers to assess the existing gap in the use of HF guideline-recommended therapy and develop interventions to improve the utilization of evidence-based guidelines.
dc.language.isoen_USen
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.subjectNursingen_US
dc.titleAdherence to Evidence-Based Pharmacological Guidelines and Outcomes for Heart Failure in Primary Care Providersen_US
dc.typetexten
dc.typeElectronic Dissertationen
thesis.degree.grantorUniversity of Arizonaen_US
thesis.degree.leveldoctoralen_US
dc.contributor.committeememberWung, Shu-Fenen_US
dc.contributor.committeememberRosenfeld, Anne G.en_US
dc.contributor.committeememberMerkle, Carrieen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.disciplineNursingen_US
thesis.degree.nameD.N.P.en_US
refterms.dateFOA2018-06-30T00:31:41Z
html.description.abstractBackground: Heart failure (HF) is a major public health problem in the United States and accounts for a large burden in rising health care expenditures. Appropriate use of evidence-based pharmacological treatment, including the use of renin-angiotensin-aldosterone inhibitors and beta-blockers can slow progression of the disease and reduce the need for hospitalization. Objectives: In a sample of individuals with HF in a primary care setting, the objectives of this study were to determine the level of providers' adherence to evidence-based pharmacological guidelines and the rate of cardiovascular-related emergency department or hospital visits. Methods: A convenience sample of patients 18 years of age and older with a diagnosis of HF was included. A retrospective chart review of 54 HF subjects was done between April and September 2014, using the American College of Cardiology Foundation and American Heart Association outpatient performance measurement set for HF. Results: Adherence to guideline recommendations for beta-blocker, angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker ARB), anticoagulation for atrial fibrillation, statin, and aldosterone receptor antagonist therapy was present in 81%, 77.8%, 78%, 80.7% and 23.1% of eligible subjects, respectively. The use of ACEIs/ARBs (OR=8.853, CI 1.212-64.66, p= 0.032) and beta-blockers (OR= 9.24, CI 1.212-70.438, p =0.031) was significantly associated with reduced number of (<1) cardiovascular-related emergency department or hospital visits after adjusted for confounders including age, sex, body mass index, and comorbidities. Conclusion: The use of ACEIs/ARBs and beta-blockers among primary care providers was comparable or higher than similar studies conducted in the primary care settings. However, despite the available evidence and recommendations, the use of aldosterone receptor antagonists in HF patients with myocardial infarction and diabetes mellitus was still low in the absence of any contraindications. These findings can be used by primary care providers to assess the existing gap in the use of HF guideline-recommended therapy and develop interventions to improve the utilization of evidence-based guidelines.


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