Cardio-Cousins: Heart Failure, Atrial Fibrillation, and Acute Coronary Syndrome

JUNE 09, 2016
Jeannette Y. Wick, RPh, MBA, FASCP
Cardiovascular disease (CVD) accounts for 30% of all deaths worldwide, and it is not just 1 disease.1 Its most common iterations are heart failure (HF), atrial fibrillation (AF), and acute coronary syndrome (ACS). Combined, the financial impact of these 3 conditions and other CVDs account for $1 of every $6 spent on health care. This translates to more than $320 billion in direct and indirect costs.2

HF, AF, and ACS are similar—but different. Their potential to cause substantial morbidity and mortality makes it critical to recognize the risk factors for these diseases (Table 1) and identify proper medications (Table 2). Reducing morbidity and mortality decreases hospitalization and emergency department (ED) visits.

Four million Americans have HF—a condition in which the heart is unable to circulate blood sufficient to meet all bodily needs.3 Symptoms vary among patients; however, breathlessness, fatigue, and edema are among the most common. HF usually develops when patients are in their mid-70s, and the risk increases drastically with age (Online Figure). HF’s potential causes include cardiac muscle failure, valve dysfunction, and increased fluid in the vasculature or pericardial area. For diagnosis, clinicians use echocardiography, magnetic resonance imaging, blood work (eg, increased plasma B-type natriuretic peptide), and cardiac catheterization.3

Pharmacists often identify these patients by their older age, dusky appearance, and long medication list; the average patient with HF takes 11 medications.4 Medications for these patients should include an angiotensin-converting enzyme (ACE) inhibitor, a beta-blocker (BB), and a diuretic—the cornerstone treatments of HF Pharmacist-provided education at discharge has been shown to improve patient outcomes, as nonadherence is a primary precipitating factor for acute, decompensated HF; therefore, adherence must be emphasized.5