Assessment of physicians’ adherence to guideline-directed medical therapy among patients with heart failure with reduced ejection fraction at the University of Gondar Comprehensive Specialized Hospital, Northwest, Ethiopia, 2023

Abstract

Background: Adhering well to guideline-directed medical therapy (GDMT) is essential for improving treatment outcomes in patients with heart failure (HF) with reduced ejection fraction (HFrEF). Despite its significance, studies on the status of GDMT adherence in patients with HF in Ethiopia are scarce. Objective: This study aimed to assess physicians' adherence to GDMT and the associated factors in patients with HFrEF. Methods: A retrospective follow-up study was conducted from September 1, 2018, to July 31, 2023. Quality of Adherence to Guideline Recommendations for Lifesaving Treatment in Heart Failure Survey scores were used to assess physicians' adherence to GDMT. SPSS version 27.0 was used for analysis, and multinomial logistic regression analysis was performed. Results: The Quality of Adherence to Guideline Recommendations for Lifesaving Treatment in Heart Failure Survey scores showed that the physicians' adherence to GDMT was good in 40% (95% confidence interval [CI] 35.30-44.90), moderate in 33.8% (95% CI 29.3-38.6), and poor in 26.2% of the study participants (95% CI 22-30.7). Age of ≥65 years (adjusted odds ratio [AOR] 0.14, 95% CI 0.07-0.29); causes of HF such as ischemic heart disease (AOR 16, 95% CI 6.75-37.90), valvular heart disease (AOR 5.3, 95% CI 2.58-10.92), dilated cardiomyopathy (AOR 8.24, 95% CI 3.97-17.09), and hypertension (AOR 6.62, 95% CI 2.98-14.69); and duration of HFrEF of ≥3 years (AOR 2.59, 95% CI 1.32-5.08) were factors significantly associated with good physicians' adherence to GDMT. Conclusion: The use of all indicated medications as per the guideline recommendation for HFrEF was low, and most patients received suboptimal doses of GDMT. Particularly, the beta-blocker dose was very suboptimal. Encouraging healthcare provider training, access to separate cardiac clinics and cardiologists, following guidelines, timely patient appointments, and medication availability are recommended for better clinical outcomes.