Torsemide versus furosemide after acute decompensated heart failure: a retrospective observational study.

BACKGROUND: Loop diuretics are recommended by clinical practice guidelines to treat volume overload in acute decompensated heart failure (ADHF). The effectiveness of switching furosemide to torsemide versus optimizing the furosemide dose following ADHF has not yet been evaluated. METHODS: This retrospective observational study aimed to assess the impact of switching furosemide to torsemide versus optimizing the furosemide dose after ADHF on HF-related hospitalization within 1 month and 6 months of discharge. The study included patients previously on furosemide admitted with ADHF to the Heart Hospital in Qatar between January 1, 2016 and June 30, 2017. The study included 2 groups: (1) patients discharged on torsemide; and (2) patients discharged on an optimized furosemide dose. Cox proportional hazard regression analysis was used to determine the association between diuretic use and hospitalization. RESULTS: Of the 232 patients included, 45 received torsemide and 187 received an optimized furosemide dose upon discharge. The majority of patients included were males (54%) with a mean age of 67 ± 12 years, and presented with HF with reduced ejection fraction (57%) and had a history of coronary artery disease (68%). The 1-month and 6-month HF-related hospitalization did not differ between the torsemide and optimized furosemide groups (aHR = 0.72; 95% CI 0.23-2.3, p = 0.57; aHR = 0.94, 95% CI 0.45-1.8, p = 0.87), respectively. CONCLUSION: Switching furosemide to torsemide after ADHF was not associated with reduced HF-related hospitalization compared to receiving an optimized furosemide dose. Larger prospective clinical trials are needed to confirm the findings of this study.

Prevalence and predictors of digoxin utilization among heart failure patients with reduced ejection fraction in Qatar.

Background Digoxin is a cardiac glycoside that is recommended by clinical practice guidelines to be used in patients with heart failure with reduced ejection fraction (HFrEF) who still have persistent symptoms despite optimal medical therapy. However, this recommendation is based on limited and old trial data. Moreover, pharmacoepidemiologic studies are important in determining the prevalence of digoxin use and factors influencing this. Objective This study aimed to determine the prevalence and the predictors of digoxin utilization among patients with HFrEF with or without atrial fibrillation (AF) in Qatar. Setting Heart Hospital, a specialized tertiary care center in Qatar. Methods A retrospective observational study was conducted using Cerner electronic medical records. Subjects included 736 patients admitted between January 1, 2013 and December 31, 2014 with the diagnosis of HFrEF with or without AF. Two groups of patients were studied: digoxin users and digoxin non-users at index hospitalization until discharge. Univariate and multivariate binary logistic regression analyses were conducted to determine the predictors of digoxin prescription. Data analyses were performed using IBM SPSS® version 23.0. Main outcome measures Prevalence and predictors of digoxin prescriptions among HFrEF patients measured in percentages and odds rations, respectively. Results A total of 736 patients who met the inclusion criteria were analyzed for digoxin prevalence, including 80 patients (11%) who were newly prescribed digoxin during the index hospitalization. After adjusting for patient demographics and clinical characteristics, the use of thiazide diuretics (aOR = 10.14, CI 2.31-44.6, p value = 0.002), concurrent AF (aOR = 8.2, CI 3.11-21.7, p < 0.001), and an ejection fraction (EF) <25% (aOR = 3.2, CI 1.5-6.8, p value = 0.002) significantly predicted digoxin prescriptions among patients with HFrEF. Conclusion The rate of digoxin prescription among patients with HFrEF in Qatar is relatively low. The strongest predictors of digoxin use in HFrEF patients were the concomitant use of thiazide diuretics and concurrent diagnosis of AF. The findings may potentially serve as useful guides for the rational utilization of digoxin in patients with HFrEF.

Diabetes patient management by pharmacists during Ramadan.

BACKGROUND: Many Muslim diabetes patients choose to participate in Ramadan despite medical advice to the contrary. This study aims to describe Qatar pharmacists' practice, knowledge, and attitudes towards guiding diabetes medication management during Ramadan. METHODS: A cross-sectional descriptive study was performed among a convenience sample of 580 Qatar pharmacists. A web-based questionnaire was systematically developed following comprehensive literature review and structured according to 4 main domains: subject demographics; diabetes patient care experiences; knowledge of appropriate patient care during Ramadan fasting; and attitudes towards potential pharmacist responsibilities in this regard. RESULTS: In the 3 months prior to Ramadan (July 2012), 178 (31%) pharmacists responded to the survey. Ambulatory (103, 58%) and inpatient practices (72, 41%) were similarly represented. One-third of pharmacists reported at least weekly interaction with diabetes patients during Ramadan. The most popular resources for management advice were the internet (94, 53%) and practice guidelines (80, 45%); however only 20% were aware of and had read the American Diabetes Association Ramadan consensus document. Pharmacist knowledge scores of appropriate care was overall fair (99, 57%). Pharmacists identified several barriers to participating in diabetes management including workload and lack of private counseling areas, but expressed attitudes consistent with a desire to assume greater roles in advising fasting diabetes patients. CONCLUSION: Qatar pharmacists face several practical barriers to guiding diabetes patient self-management during Ramadan, but are motivated to assume a greater role in such care. Educational programs are necessary to improve pharmacist knowledge in the provision of accurate patient advice.