Adherence to Guideline Directed Medical Therapy in Heart Failure Patients in a Tertiary Hospital in Southern Nigeria: A Real-World Experience

Abstract

: Background : There is an increase in the incidence of heart failure among the sub-Saharan population. The use of guideline-directed medical therapy has been shown not only to reduce disease progression but also frequent hospitalization, morbidity, and mortality from heart failure. This study was directed at identifying which of the major drug class for treatment of heart failure was incorporated by the physicians in the area. Methodology : The study involved collection of data from patient’s records using an observational checklist. A total of 166 heart failure patients with reduced EF were recruited between the age ranges of 33 and 95 years. The medications prescribed, date of drug initiation and progress in optimization of therapy were assessed over a 1-year period and data analyzed using SPSS version 25. A p-value of 0.05 and below was considered statistically significant. Results : The result showed that the most prevalent causes of heart failure were hypertensive heart disease (70.5%), followed by dilated cardiomyopathy (15.7%) and valvular heart disease (6.6%). The use of diuretics was prevalent among study cohorts at 87.4%, followed by Mineralocorticoid antagonist (MRAs) (78.3%), ARB/ACEI/ARNI (68.1%), beta blockers (40.4%), and less than a third of patients were on SGLT2 inhibitors (28.9%). The dosing of heart failure medications was noticed to be fixed without up-titration of doses at intervals for most classes of GDMT except the MRAs. Only about 2.4% of the study cohorts had dose optimization over this period and most study patients were not on optimal maximal doses of heart failure therapy. Conclusion : The use of guideline directed medical therapy has improved amongst HF patients however up titration of doses remains a major problem amongst patients managed in our clinic. The implementation of a multi-disciplinary HF clinic focused on improvement of outcomes of HF patient is essential in improving not only the use of Guideline-directed medical therapy (GDMT) but up-titration to optimal doses for maximal benefits.