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Aug 6, 2023Keywords:
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Assessment of physician adherence to guideline recommended medication in heart failure with reduced ejection fraction at outpatient cardiac clinic; retrospective cross- sectional study at tikur anbessa specialized hospital
Abstract
Background-Heart failure (HF) is a burden for the healthcare system. There is clear evidence from landmark studies that optimal uses of Angiotensin-converting-enzyme inhibitors (ACEI), Angiotensin receptor blockers (ARBs), Beta-blockers (BB), and Mineralocorticoid receptor antagonists (MRAs) to achieve target dose used in RCTs improves survival and reduce morbidity in patients with HF with reduced ejection fraction (EF). The objective of this study is to evaluate physicians’ adherence to guideline-recommended medications for treatment of heart failure with reduced ejection fraction (HFrEF)
Method-Retrospective cross-sectional study was conducted and the medical record of 364 patients with HFrEF treated at TASH from 2012 to 2018 was reviewed. Global class adherence score (GCA) was used to evaluate the use of ACEI, BB, ARB, and MRAs according to the international guideline by physicians. SPSS 20 software was used for data entry and analysis.
Result-GCA score among physicians was good in 36%, moderate in 47%, poor in 17% of the study patients. Class adherence for the individual drug was 67% for ACEI, 48.7% for MRA, and 73.6% for Beta-blockers. The proportion of patients at target dose (100%) was 7.6% for ACEI, 0.8% for Beta-blockers, and 1% for MRA. Use of more than 50% target dose was 36.7 % for ACEI, 6.6% for beta-blocker, 49% for MRA. Duration of heart failure > 5 years was associated with a good GCA (P=0.003). Diabetic patients were prescribed higher doses of ACEI, compared to non-diabetics (p=0.001).
Conclusion In this study use of all indicated medication as per guideline by physicians was low (36%) and the majority of patients received less than 50% target dose, especially for beta-blocker and ACEIs.
