Emergency Department Use of Heart Failure-Exacerbating Medications in Patients with Chronic Heart Failure

Martin F. Casey (), Joy Hallmark, Patricia P. Chang, Jo E. Rodgers, Aakash Mehta, Srihari V. Chari, Preston Skersick, Thomas Bohrmann, Parag Goyal and Michelle L. Meyer
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Martin F. Casey: University of North Carolina School of Medicine
Joy Hallmark: University of North Carolina School of Medicine
Patricia P. Chang: University of North Carolina School of Medicine
Jo E. Rodgers: University of North Carolina
Aakash Mehta: University of North Carolina School of Medicine
Srihari V. Chari: University of North Carolina School of Medicine
Preston Skersick: University of North Carolina
Thomas Bohrmann: Analytical Partners Consulting LLC
Parag Goyal: Division of Cardiology, Weill Cornell Medicine
Michelle L. Meyer: University of North Carolina School of Medicine

Drug Safety, 2024, vol. 47, issue 12, No 4, 1225-1234

Abstract: Abstract Background Use of heart failure-exacerbating medications (HFEMs) may lead to preventable episodes of acute decompensated heart failure (HF). HFEMs use is common in patients with HF, and there may be opportunities to reduce their use from the emergency department (ED). Methods We performed an observational study on patients with HF presenting to EDs within a healthcare system between 1 January 2016 and 31 December 2020. Patients with chronic HF were identified using diagnostic codes within the electronic health record. The cohort was restricted to ambulatory (i.e., discharged to home) ED encounters. Medications, either ordered in the ED or prescribed at ED discharge, were extracted from the medication administration record and identified as potential HFEMs based on the 2016 American Heart Association Scientific Statement. Descriptive statistics were used to summarize the prevalence of HFEM use during ambulatory ED encounters. Exploratory analyses to identify correlates of HFEM use were performed. Results The study cohort included 23,907 ED encounters. ED administration or prescription of HFEMs occurred during 20% of ambulatory ED encounters. HFEM administration in the ED (17%) was more common than HFEM prescription at ED discharge (6%). The most common HFEMs administered in the ED included nonsteroidal anti-inflammatory drugs (11%) and albuterol (7%). Conclusion HFEM use is common in patients with HF seeking ED care, occurring in roughly one-fifth of ambulatory ED encounters. There may be opportunities to optimize medication use among patients with HF in the ED.

Date: 2024
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DOI: 10.1007/s40264-024-01479-5

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