[Optimization of heart failure treatment in Abidjan heart institute]

The aim of the study was to assess the level of treatment optimization after follow-up at discharge.

We conducted a retrospective study carried out from January 1st, 2016 to December 31st, 2018 in Abidjan Heart Institute with patients hospitalized for heart failure and reviewed in consultation.

The study involved 350 patients with an average age of 53.53 ± 16.38 years (54% were males). The prescription of diuretics (92%) after optimization was at the mean and with maximum doses of 29.1% and 7.7%. ACEIs/ARBs (77.1%) had optimal and mean doses for ACEIs of 14.3% and 29.7%. With beta-blockers (72.6%) there was an improvement in doses at 35.4% for the average doses and 3.1%. for the maximum dose. Spironolactone (44.3%) kept the same average dose at 5.7% The median time of optimization was 287.05 days with a median of 140 days. Only 13.4% of patients were receiving optimal treatment at optimal doses. By logistic regression, the presence of LVEF ≤ 0,40 or LVEF= 0.41-0.49 or global heart failure (P < 0.001) favored drug optimization (OR = 24.68[7.15-82.22], P < 0.001); (OR = 11.39[3.25-39.86], P < 0.001) on the other hand, a high serum creatinine level was an obstacle for treatment optimization (OR = 0.92[0.88-0.96], P < 0.001).

The optimization of the treatment of heart failure is insufficient with too long delays in our context. The optimization time was so long. It could be improved by setting up a clinic to optimize the treatment of heart failure.