Barriers to Optimising Medication for Patients With Heart Failure With Reduced Ejection Fraction (HFrEF)

Objective The 2020/2021 National Heart Failure Audit found prescribing rates of beta‐blockers, angiotensin‐converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs) and mineralocorticoid receptor antagonists (MRAs) were below target levels in individuals with heart failure with reduced ejection fraction (HFrEF). In Sheffield Teaching Hospitals (STH), prescribing rates of this triple therapy (TT) were below the national average. The aim of this study was to evaluate the impact of patients’ frailty and comorbidities on TT prescribing rates. Methods We analysed the clinical details of individuals with a diagnosis of moderate or severe HFrEF admitted to STH between May 2021 and December 2021. Patients’ electronic notes, investigations and heart failure specialist nurses’ assessments were reviewed. Results Electronic records of 310 patients were reviewed. About 45.5% were discharged on appropriate TT, compared to 52% nationally. Prescribing rates were 84.2% for beta‐blockers and 61.3% for ACE‐i/ARB/ARNIs, compared to national levels of 91% and 84%, respectively. The prescribing rate for MRA was 63.4%, which is higher than the national average (61%). About 92.6% of those not on TT had a documented clinical reason, with the commonest being ‘poor renal function’ (45.6%) and ‘low systolic blood pressure’ (25.5%). Those not on TT had a greater mean clinical frailty score (4.4 vs. 3.0, p < 0.001), were older (78.4 vs. 67.1, p < 0.001) and had worse 12‐month readmission ( p < 0.001) and mortality rates ( p < 0.001). Conclusions Patients’ frailty and comorbidities play a significant role in HFrEF‐prescribing patterns. Identifying and addressing the barriers to optimal HFrEF treatment may improve prescribing rates and patient outcomes.