Adherence to Guideline-Directed Medical Therapy Target in patients with heart failure and reduced ejection fraction: a cross-sectional study.

Background: Heart failure with reduced ejection fraction (HFrEF) represents a compelling cause of hospital morbidity and mortality in Brazil. There is low adherence to guideline-directed medical therapy (GDMT), which in turn, can result in higher morbidity and mortality.

Objectives: The present study aims to evaluate adherence to GDMT in patients with HFrEF in a Brazilian University hospital service.

Design and settings: Observational, cross-sectional, single-center study conducted at the Hospital Universitário Professor Edgard Santos (HUPES), Salvador, BA, Brazil.

Methods: The study was conducted with convenience sampling at the cardiology outpatient clinic of a university hospital service. Patients with left ventricular ejection fraction (LVEF) < 40% who had reverse remodeling were excluded.

Results: 289 patients were included, with mean age 63 years, 54.7% were male, 56,4% mixed-race and 27,7% had Chagasic cardiomyopathy. 93.1% were prescribed ACEi, ARB or ARNi, 95.8% betablockers, 69.2% spironolactone and 8% the combination hydralazine/isosorbide-dinitrate. 71,7% were using enalapril, losartan or ARNi above 50% of GDMT target doses; 81,2% were using beta-blockers and 100% were using spironolactone. Only 21,2% were prescribed GDMT target doses of enalapril, losartan or ARNi and 52,3% of beta-blockers. 98,5% of spironolactone prescriptions reached GDMT target doses.

Conclusions: We found high frequencies of prescription of GDMT for HFrEF, considering the therapeutic goals recommended by cardiology guidelines, but, prescription of target doses were low in ACEi, ARB or ARNi and beta-blockers.