Development and validation of algorithms for heart failure patient care: a Delphi study

<p><b>INTRODUCTION</b>Although heart failure (HF) management is available at primary and secondary care facilities in Malaysia, the optimisation of drug therapy is still suboptimal. Although pharmacists can help bridge the gap in optimising HF therapy, pharmacists in Malaysia currently do not manage and titrate HF pharmacotherapy. The aim of this study was to develop treatment algorithms and monitoring protocols for angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers and spironolactone based on extensive literature review for validation and utilization by pharmacists involved in HF management.</p><p><b>METHODS</b>A Delphi survey involving 32 panellists, from private and government hospitals that provide cardiac services in Malaysia, was conducted to obtain a consensus opinion on the treatment protocols. The panellists completed two rounds of self-administered questionnaires to determine their level of agreement with all the components in the protocols.</p><p><b>RESULTS</b>Consensus agreement was achieved for most of the sections of the protocols for the four classes of drugs. Panellists' opinions were taken into consideration when amending the components of the protocols that did not achieve consensus opinion. Full consensus agreement was achieved with the second survey conducted, enabling the finalisation of the drug titration protocols.</p><p><b>CONCLUSION</b>The resulting validated HF titration protocols can be used as a guide for pharmacists when recommending the initiation and titration of HF drug therapy in daily clinical practice. Recommendations should be made in collaboration with the patient's treating physician, with concomitant monitoring of patient's response to the drugs.</p>

Determinants of functional status among survivors of severe sepsis and septic shock: one-year follow-up

Sepsis is a leading cause of intensive care unit [ICU] admissions worldwide and a major cause of morbidity and mortality. Limited data exist regarding the outcomes and functional status among survivors of severe sepsis and septic shock. This study aimed to determine the functional status among survivors of severe sepsis and septic shock a year after hospital discharge. Adult patients admitted between April 2007 and March 2010 to the medical-surgical ICU of a tertiary hospital in Saudi Arabia, were included in this study. The ICU database was investigated for patients with a diagnosis of severe sepsis or septic shock. Survival status was determined based on hospital discharge. Patients who required re-admission, stayed in ICU for less than 24 hours, had incomplete data were all excluded. Survivors were interviewed through phone calls to determine their functional status one-year post-hospital discharge using Karnofsky performance status scale. A total of 209 patients met the eligibility criteria. We found that 38 [18.1%] patients had severe disability before admission, whereas 109 [52.2%] patients were with severe disability or died one-year post-hospital discharge. Only one-third of the survivors had good functional status one-year post-discharge [no/mild disability]. After adjustment of baseline variables, age [adjusted odds ratio [aOR] = 1.03, 95% confidence interval [CI] = 1.01-1.04] and pre-sepsis functional status of severe disability [aOR = 50.9, 95% CI = 6.82-379.3] were found to be independent predictors of functional status of severe disability one-year post-hospital discharge among survivors. We found that only one-third of the survivors of severe sepsis and septic shock had good functional status one-year post-discharge [no/mild disability]. Age and pre-sepsis severe disability were the factors that highly predicted the level of functional status one-year post-hospital discharge