RESUMO
BACKGROUND: Ivabradine is recommended in heart failure (HF) patients to reduce cardiovascular death and hospitalization due to worsening of HF symptoms. AIMS AND OBJECTIVES: To study the effect of Ivabradine in addition to guideline-directed medical therapy (GDMT) in a group of HF patients with HR more than 70 bpm, HF with reduced ejection fraction (HFrEF) left ventricular ejection fraction (LVEF ≤ 40%), and New York Heart Association class II-IV. METHODS: The study was conducted at Heart Hospital, Hamad Medical Corporation, Qatar. HF patients with age > 18 years, LVEF ≤40%, on GDMT, and HR of ≥70 bpm were included. The study population was divided into two groups: ivabradine group and non-ivabradine group. The primary outcomes were risk, number and length of hospitalizations due to worsening HF, and cardiovascular mortality. The secondary outcome was all-cause mortality. Baseline characteristics were collected at enrollment. Study outcomes were compared in the two groups by applying Chi-square and Fisher's exact tests. Logistic regression model was applied to assess both hospitalizations and cardiovascular mortality. RESULTS: A total of 111 patients were studied, 37 (33.94%) ivabradine group and 74 (66.67%) non-ivabradine group. Risk of hospitalization was lower in Ivabradine group compared to non-Ivabradine group (odds ratio: 0.43, 95% confidence interval [CI]: 0.16-1.015, P = 0.094). Average length of hospitalization in ivabradine and non-ivabradine groups was 12.54 and 8.91 days, respectively (incidence rate ratio [IRR]: 1.63, 95% CI: 0.79-3.38, P = 0.187). Compared to non-ivabradine, ivabradine patients had lower number of hospitalizations (IRR: 1.13, 95% CI: 0.61-2.11, P = 0.694). Death rate in both ivabradine and non-ivabradine groups was 3. CONCLUSIONS: Ivabradine along with GDMT reduces the risk of hospitalization due to worsening HF symptoms. Ivabradine had no significant effect on cardiovascular mortality and all-cause mortality. HFrEF non-Arabs patients have lower risk, number and length of hospitalization, and mortality compared to Arabs.
RESUMO
BACKGROUND: Medication use review (MUR) is increasingly being recognized globally as a routine strategy performed by pharmacists to optimize the therapeutic outcomes of long-term medications. MUR services are not commonly available in hospitals and primary health care (PHC) centers in Qatar and no previous studies have reported the nature and extent of such services where they exist. OBJECTIVE: To describe the extent and types of drug-related problems (DRPs) generated from MUR interactions conducted at a PHC facility in Qatar and to determine the effect of patient characteristics on the number of DRPs. METHOD: This was a cross-sectional, descriptive and exploratory study. Data were generated and documented prospectively via semi-private interviews conducted by intervention pharmacists (n = 6). DRPs identified were categorized according to the Pharmaceutical Care Network of Europe DRP classification system. RESULTS: In 56 medication reviews conducted, a total of 173 DRPs were identified with an average of 3.3 DRPs per patient. The most commonly encountered DRPs were non-adherence (31 %), need for education (23 %), and adverse drug reactions (21 %). Patients receiving six or more medications had significantly higher number of DRPs compared to those receiving three medications (p ≤ 0.05). Furthermore, elderly patients tended to have more DRPs compared to younger patients and there was a linear relationship between age and DRPs. CONCLUSION: This study shows that patients receiving polypharmacy and the elderly in Qatar are vulnerable to experiencing DRPs, many of which are potentially preventable through MURs.
