Category: Federal Forum Posters
Purpose: Beta blockers (BBs) serve a critical role in managing heart failure with reduced ejection fraction (HFrEF). In particular, metoprolol succinate, carvedilol, and bisoprolol have been shown to reduce morbidity and mortality in these patients. Appropriate utilization of these medications improves symptoms, reduces hospitalizations, and increases survival. Other BBs have not been proven to provide these same benefits. Previously at the Sheridan VA Healthcare System (SVAHCS), an automatic conversion of non evidence-based BBs to metoprolol succinate was approved. This medication use evaluation will serve to ensure BB conversion has been completed and to evaluate the facility’s use of these agents.
Methods: A patient list was generated from Microsoft SQL that included all Veterans within the Sheridan VA Healthcare System (SVAHCS) with active prescriptions for atenolol or metoprolol tartrate and a HF diagnosis. Retrospective chart reviews were performed for each patient using the electronic medical record. The following data were collected: age; sex; race; weight, blood pressure, pulse; cardiac medication regimen; NYHA HF class, HF related hospitalizations, ejection fraction (EF); and safety information. Recommendations for conversion of non-evidenced-based BB to metoprolol succinate were provided to prescribers through documentation entered into the patient’s chart.
Results: There were 54 patients identified with active prescriptions for metoprolol tartrate (n = 47) and atenolol (n = 7). Only 63% had a HF diagnosis listed on the problem list, with 27.8% being listed elsewhere in the electronic health record and the remaining 9.2% having no mention of HF. The NYHA class was only documented in 5 patients. Twelve patients had a hospitalization related to HF within the past year. Regarding concurrent cardiac medications, use of a diuretic was most common (n = 44). Other cardiac medications included ACE-I/ARB (n = 37), aldosterone antagonist (n = 8), isosorbide mononitrate (n = 4), diltiazem (n = 2), digoxin (n = 2), and amlodipine (n = 1). A majority of patients had EF greater than 40% indicative of HF with preserved ejection fraction (n = 37). Seven patients had no documented and EF and the remaining 10 had an EF less than or equal to 40%. Of those with an EF less than or equal to 40%, 3 had a questionable HF diagnosis and 3 had a more recent EF greater than 40%. Four patients were found to be appropriate for conversion to metoprolol succinate and 3 were successfully converted.
Conclusion: The results of this MUE were presented to the Pharmacy and Therapeutics Committee. Clinical education was provided to prescribers and pharmacists regarding appropriate use of BB in patients with HFrEF and the importance of consistent documentation within the electronic health record.