Optimization of Guideline directed Medical Therapy and associated factors, among adult heart failure patients on follow up at Jimma University Medical Center follow up clinic, Jimma, Southwest Ethiopia; a Cross-sectional Study.

Abstract

Heart failure (HF) poses a significant global health concern, with substantial morbidity, mortality, and economic burden. Among heart failure patients, those with reduced ejection fraction (HFrEF) constitute around 60%. Recent society guidelines recommend use of Guideline medical therapy (GDMT) which include four group of pillar drugs at their optimal dose in order to reduce not only hospitalization but also heart failure symptom and mortality. Despite this recommendation the drugs are underutilized because of different factors. Objective: To assess the magnitude of utilization of GDMT and associated factors among patients with HFrEF at JUMC cardiac follow up clinic of Jimma University Medical Center. Methods: A cross-sectional study was conducted on selected patients with HFrEF on follow up between June 2023 and Sept 2023at ambulatory care clinic of Jimma University Medical Center, Ethiopia. Data was collected through patient interview and review of medical records. Collected data was first cleaned, edited and entered into a computer and analyzed using software program SPSS Version 24. Adjusted Odds Ratio with 95% CI was used to measure strength of association. A P-value of <0.05 is considered statistically significant for associated factors. Result: The study’s findings indicate that only 12 patients (4.7%) received guideline-directed medical therapy, and this achievement was substantially correlated with the diagnosis of hypertension (AOR: 10.62, 95% CI: 1.14-98.37) and diabetes mellitus (AOR: 7.73, 95% CI: 3.85-19.86). Despite high prescription rates for ACEIs/ARBs 244(96.1%), beta-blockers (226 patients, 85.97%), and MRAs 218(85.82%), the prescription of SGLT2 inhibitors was notably infrequent 22(8.7%). Moreover, a relatively small percentage of patients achieved target dosages, with just 76(29.9%) for ACEIs/ARBs, 32(12.6%) for MRAs, and 9(3.5%) for beta blockers. The primary barrier to this was physician inertia, with a significant number of patients not receiving dosage escalations without documented reasons: 129(76%) for ACEIs/ARBS, 109 (49.8%) for beta-blockers, and 147(79%) for MRAs. SGLT2 inhibitors were not offered to 161 patients (63.4%). Medication-related side effects or intolerance also hindered the achievement of target dosages for 31(18%) of ACEIs/ARBs, 61(21.5%) for beta-blockers, and 25(13.4%) for 6 MRAs. Furthermore, cost was cited as a barrier for 10 (5.7%) of ACEIs/ARBs, 61(21.5%) of beta-blockers, and 14 (7.5%) of MRAs users. Conclusion and recommendation: The study sheds light on a notable gap in the application of guideline-directed medical therapy, with only a minority of patients reaching the advised target doses. Given the underuse of SGLT2 inhibitors and the low rate of achieving target doses for essential medications, it might be beneficial for healthcare systems to consider strategies that can help to overcome physician inertia, which hinder the delivery of optimal patient care. Furthermore, enhancing the availability and affordability of SGLT2 inhibitors may be advantageous in the context of their prescription patterns.