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

Area of Science:

• Pharmacology
• Clinical Pharmacy
• Cardiology

Background:

• Heart failure (HF) drug therapy optimization remains suboptimal in Malaysia.
• Pharmacists are well-positioned to improve HF management but lack formal protocols.
• Current HF pharmacotherapy management lacks standardized guidelines for Malaysian pharmacists.

Purpose of the Study:

• To develop and validate treatment algorithms and monitoring protocols for key HF medications.
• To create guidelines for angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and spironolactone.
• To empower pharmacists in Malaysia to manage and titrate HF pharmacotherapy.

Main Methods:

• A Delphi survey was employed with 32 expert panellists from Malaysian cardiac services.
• Two rounds of self-administered questionnaires were used to achieve consensus on treatment protocols.
• Extensive literature review informed the development of the initial treatment algorithms.

Main Results:

• Consensus was achieved on most sections of the HF drug titration protocols after two survey rounds.
• Panellists' feedback was incorporated to refine protocols lacking consensus.
• Finalized drug titration protocols were developed based on expert agreement.

Conclusions:

• Validated HF titration protocols provide a guide for pharmacists in Malaysia.
• These protocols facilitate pharmacist recommendations for initiating and titrating HF drug therapy.
• Collaboration with physicians and patient monitoring are crucial for effective HF management using these protocols.