Marcia Brackbill, BCPS, PharmD
Professor of Pharmacy
Shenandoah University
Stephens City, VA
Disclosure information not submitted.
Holly Bartomioli
Student Pharmacist
Shenandoah University
Winchester, Virginia, United States
Disclosure information not submitted.
Title: Home Heart Failure Medication Regimens in Males Compared to Females Admitted for ADHF
Introduction: Current guidelines recommend ARNIs, ACEI, ARBS, and beta-blockers (BBs) for patients with HFrEF. Recent European studies provide insight that a gender specific dosing regimen would be beneficial in HFrEF patients, suggesting that females would benefit from lower doses of ACEIs, ARBs and BBs than men. In females, the largest treatment benefit was observed at 50% of the recommended target dose, achieving 30% lower mortality or hospitalization. The objective of this study was to determine the percentage of recommended target doses of medications achieved prior to admission for ADHF in males and females.
Methods: A retrospective chart review was performed. Patients with an admitting diagnosis of ADHF were included if they had a prior documented diagnosis of HFrEF and a LVEF < 40%. Patients were excluded if they were less than 18 years old or a home medication list was not available. Patients were placed in one of two study groups: males vs females. The primary endpoint was to determine the percentage of guideline recommended target dose achieved for ACEIs in males vs females based on the home medication list. Secondary endpoints evaluated target doses achieved for ARBs, ARNIs and BBs and hospital length of stay. Endpoints were evaluated using Chi Square for nominal variables and Student's t-test for continuous variables.
Results: A total of 157 patients were included, 96 males and 61 females. A higher percentage of males (36%) were on an ACEI compared to females (21%), p=0.03. More males (74%) were on a beta blocker compared to females (54%), p=0.012. For the primary endpoint, males on an ACEI were at 37.5% ± 29.4 of guideline recommended target doses compared to females at 57.7% ± 37.0 of target dose (p=0.055). No differences were found for the other medication classes evaluated. The average length of hospital stay for males was 5.6 ± 4.7 days compared to 5.7 ± 4.8 days for females (p=0.909).
Conclusions: No differences were observed between males and females in the percentage of target dose achieved for any of the medication classes evaluated in this study. With newer literature indicating females may benefit from lower doses of essential HF medications, further research is warranted to evaluate whether clinicians should strive to reach the target ranges recommended in the HF guidelines.