6. Sensible prescribing in older people with Jonathan and Lucy; Heart failure with preserved ejection fraction

Welcome to the latest episode of Talking Meds on the PrescQIPP podcast, engaging conversations about medicines-related dilemmas. Today, your host Jonathan Underhill, Medicines Clinical Adviser at PrescQIPP, continues the series within the Talking Meds podcast called ‘Sensible prescribing in Older people with Jonathan and Lucy’. 

Today, Jonathan and Lucy talk about the identification AND sensible management of heart failure with preserved ejection fraction. They discuss how we need to have a different approach than that for heart failure where the ejection fraction is reduced by a significant amount. But that the key is to consider what matters most to people and tailor our approach accordingly. Its guidelines not tramlines!

The importance of ‘sick day rules’ are also discussed – stopping medicines for a short period where volume depletion or a urinary tract infection (UTI) is present.

We also meet Marjory, who has recently been started on dapagliflozin but is admitted to hospital with a raging UTI and delirium. The EMPORER study found that for every 100 people on a flozin, one of them would get a UTI due to the flozin. But this risk may be higher in older people as they are at higher risk of this happening in the first place than those included in the EMPORER study. Medicine is tricky eh?

See the tab for HFPrEF in GP Evidence https://gpevidence.org/ to illustrate this with icon arrays.

Resources mentioned in this episode include:

P Moorhouse, K Rockwood. Frailty and its quantitative clinical evaluation

National Institute for Health and Care Excellence. Urinary tract infection (lower): antimicrobial prescribing

NICE guideline [NG109]Published: 31 October 2018

PrescQIPP bulletin 347. Chronic Heart Failure

PrescQIPP e-learning. Chronic Heart Failure in Adults (pay per use)

A new episode of Talking Meds will be available every other Friday.
If you have feedback or suggestions for future topics and guests please submit them to talkingmeds@prescqipp.info

PrescQIPP is funded by the NHS for the NHS, and our aim is to improve medicines-related care for patients. We do this by producing high quality evidence-based resources and training, and by facilitating networks between NHS organisations and professionals.

The majority of pharmacists and other healthcare professionals across the UK can access our resources by registering and logging on to our website. If you have any difficulty accessing the website you can email help@prescqipp.info and we’ll aim to sort things out for you.

Find out more about PrescQIPP here