Department of Emergency Medicine, University of North Carolina School of Medicine, 170 Manning Dr, CB# 7594, Chapel Hill, NC, 27599-7594, USA.
Division of Cardiology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Drug Saf. 2024 Dec;47(12):1225-1234. doi: 10.1007/s40264-024-01479-5. Epub 2024 Sep 12.
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).
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.
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%).
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.
心力衰竭加重药物（HFEMs）的使用可能导致可预防的急性失代偿性心力衰竭（HF）发作。HFEMs 在 HF 患者中使用较为常见，并且可能有机会从急诊科（ED）减少其使用。
我们在 2016 年 1 月 1 日至 2020 年 12 月 31 日期间，对在医疗保健系统内就诊于 ED 的 HF 患者进行了一项观察性研究。通过电子病历中的诊断代码识别出慢性 HF 患者。该队列仅限于非住院（即，出院回家）ED 就诊。从药物管理记录中提取药物，并根据 2016 年美国心脏协会科学声明，将其识别为潜在的 HFEMs。使用描述性统计数据总结在非住院 ED 就诊期间 HFEM 使用的流行率。进行了探索性分析，以确定 HFEM 使用的相关因素。
该研究队列包括 23907 例 ED 就诊。在 20%的非住院 ED 就诊中，ED 管理或处方 HFEMs。ED 内 HFEM 管理（17%）比 ED 出院时 HFEM 处方（6%）更为常见。在 ED 内管理的最常见的 HFEM 包括非甾体抗炎药（11%）和沙丁胺醇（7%）。
在寻求 ED 治疗的 HF 患者中，HFEM 使用较为常见，在大约五分之一的非住院 ED 就诊中出现。在 ED 中，可能有机会优化 HF 患者的药物使用。
