Therapeutic Inertia in Blood Pressure Control & Heart Failure

Abstract

Specific Aims: To analyze therapeutic inertia as it relates to blood pressure control in patients with heart failure in an ambulatory care setting compared to American College of Cardiology/American Heart Association (ACC/AHA) guidelines and landmark trial recommended therapy. Methods: Data were collected via retrospective chart review using the electronic record in Cerner from a local patient cohort. Data were collected for over a year and included the two most recent blood pressure measurements. Patients included were part of a dual eligible cohort and identified using Cerner Dynamic Worklist coding for a diagnosis of heart failure. Therapeutic inertia was analyzed with current doses of heart failure medications compared to the landmark trials. Evaluation of blood pressure control was based on the ACC/AHA guideline goal of less than 130/80 mmHg. Data were analyzed using a chi-square test and t-test. The level of significance (p) was set at 0.05. Results: A total of 55 patients were evaluated, and two blood pressure readings were collected for each (17 male, 38 female). Overall 56% of all patients had controlled blood pressure. Analysis of systolic and diastolic blood pressures were statistically different with a p-value of <0.01. Although therapeutic inertia was observed in 54% of patients no statistically significant difference was found between blood pressure control and therapeutic inertia. Conclusions: Therapeutic inertia was common, and blood pressure was often higher than the ACC/AHA recommendation for heart failure.