Year of Publication

2015

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Mollie Aleshire

Clinical Mentor

Peggy Hardesty

Committee Member

Dr. Kathy Wheeler

Abstract

Background: ACEI has been shown to help decrease mortality, morbidity, rate of re-hospitalization, and to improve symptoms of heart failure (HF). However, the rate of ACEI use for HF patients remain low despite the recommendations made by the ACCF/AHA Task Force in the current 2013 HF guideline. It is important to increase the use of ACEI because of its positive effect on the outcome of HF. In addition, improper charting could skew the number of patients who are actually taking ACEI, making it less than it actually it. Thus, providers should be on the forefront of encouraging ACEI use, especially for HF patients.

Purpose: The purpose of this study is to evaluate if heart failure patients, aged 18 and over, in a primary care clinic receive ACEI therapy as recommended by the current 2013 HF guideline written by the American College Cardiology Foundation/American Heart Association (ACCF/AHA) Task Force.

Methods: This is a retrospective chart review study that will assess for documentation of ACEI therapy in heart failure patients. Unique medical records meeting the inclusion criteria will be reviewed for: the number of patient encounters within the past year, visit day of the week, age, ethnicity, gender, type of health insurance (Medicare, Medi-Cal, private insurance, and uninsured), select vital signs (systolic blood pressure, diastolic blood pressure, and heart rate), ACEI on current active medication list, generic name of ACEI, dose of ACEI, and frequency of ACEI per day. If the patient does not have an ACEI on the current, active medication list, the chart will be reviewed over the year prior to the patient encounter for documentation of an ACEI on active medication list within the past year, an angiotensin-receptor blocker (ARB) on the patient medication list, a hydralazine/isosorbide combination on the patient medication list, allergy to ACEI, cough due to ACEI, hypotension due to ACEI, angioedema due to ACEI, and documentation of other reason for not being on ACEI. Additionally, a focus group will be held after results are analyzed. The focus group will have result dissemination and questions for discussion with providers.

Results: 63 charts were reviewed, and the results showed that only 20.6% of patients were currently taking ACEI for HF. The most common cause of not taking ACEI was due to allergies. Out of the 50 charts that did not have ACEI on the current medication list, 42% did not have any type of documentation on why the patient was not on an ACEI. The focus group found that barriers to utilization of ACEI for HF patients included improper or incomplete documentation by the medical assistants (MAs), medication list not up to date because the MAs did not take the time to go through the list with patients, and patient’s lack of knowledge on the disease process and treatment of HF.

Conclusion: Based on the results of the study, proper medication reconciliation by the patient and MAs could help to improve documentation and improve the number of actual ACEI use. Decreasing patient load could help improve quality of patient and increase patient satisfaction. This will increase patient involvement in the treatment plan, thus increasing rate of adherence to ACEI. Lastly, continuous guideline education will encourage provider to use evidence-based therapies to treat HF.

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