A Review of Discharge Medications in Patients Admitted with Acute Decompensated Heart Failure in a Tertiary Referral Centre

Background: National guidelines for heart failure recommend prescription of certain classes of drugs to improve prognosis in patients admitted with acute decompensated heart failure (ADHF). It has been noted during clinical follow up such patients are discharged with different treatment regimes. Objective: To determine the relationship between drug treatment regimes in patients admitted to a tertiary referral centre with ADHF and their medium term clinical outcomes post-discharge, defined as 90-day mortality and hospital readmissions. Methods: 94 cases with a discharge diagnosis of ADHF were recruited from October 2017 until August 2018. Cases were analyzed retrospectively for their medications at discharge. Patients were followed-up for 90 days via phone. Results: Out of 94 patients, 8 patients died during admission. 86 patients were being analysed for clinical outcomes. 22 (26%) patients were discharged without a single type of guideline recommended medication for heart failure (GRM). 33 (38%) patients were discharged on one type, 22 (26%) patients discharged with two types and 10 (12%) patients were discharged with three or more types of GRM. The main reasons for not being discharged with all GRM were chronic kidney disease, obstructive lung disease, bradycardia and hypotension. The 90 days mortality rate was higher in patients discharged with ≤1 class of GRM drugs compared to patients with discharged on ≥2 classes of GRM drugs. (14.5% vs 6.5%; OR 2.25; 95%CI 0.51, 9.96; p=0.28). The 90 days readmission rate for ADHF was also higher for patients discharged with ≤1 class of GRM drugs (20.0% vs 12.9%; OR 1.55; 95%CI 0.539, 4.457; p=0.416). Overall, patients with discharged with ≤1 class of GRM drugs had also a higher 90-day event rate (27.3% vs 19.4%; OR 1.78; 95%CI 0.797, 3.993; p=0.16). Conclusions: Discharging ADHF patients with ≥2 class of GRM drugs was associated with lower 90 days readmission rates and mortality. Even at a tertiary referral centre, every effort should be made to ensure patients admitted with ADHF are discharged on GRM