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Adherence to Guideline-Directed Medical Therapy Target in patients with heart failure and reduced ejection fraction:
Fábio Figueirêdo Costa1, Andréa Karoline Reis Chagas1, Anna Cláudia Monteiro Luz Santos1
1Department of Cardiology, Hospital Universitário Professor Edgard Santos (HUPES), Universidade Federal da Bahia (UFBA), Empresa Brasileira de Serviços Hospitalares (EBSERH), Salvador, BA, Brazil.
Insights
Adherence to guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) is high in Brazil, but target doses for key medications like ACEi, ARB, or ARNi, and beta-blockers are frequently not met.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Heart failure with reduced ejection fraction (HFrEF) significantly contributes to hospital morbidity and mortality in Brazil.
- Low adherence to guideline-directed medical therapy (GDMT) is associated with increased HFrEF-related morbidity and mortality.
Purpose of the Study:
- To assess the adherence to GDMT in patients diagnosed with HFrEF.
- To evaluate the prescription patterns and target dose achievement of GDMT in a Brazilian university hospital setting.
Main Methods:
- An observational, cross-sectional, single-center study was conducted at Hospital Universitário Professor Edgard Santos (HUPES) in Salvador, BA, Brazil.
- Convenience sampling was employed at the cardiology outpatient clinic, including patients with left ventricular ejection fraction (LVEF) < 40%, excluding those with reverse remodeling.
Main Results:
- The study included 289 patients (mean age 63, 54.7% male, 56.4% mixed-race; 27.7% with Chagasic cardiomyopathy).
- Prescription rates for ACEi/ARB/ARNi (93.1%), beta-blockers (95.8%), and spironolactone (69.2%) were high.
- While many patients received GDMT (e.g., 71.7% using ACEi/ARB/ARNi >50% target dose), only 21.2% achieved target doses for ACEi/ARB/ARNi and 52.3% for beta-blockers. Spironolactone prescriptions (98.5%) frequently reached target doses.
Conclusions:
- High rates of GDMT prescription were observed for HFrEF patients in this Brazilian cohort.
- However, achieving guideline-recommended target doses for ACEi, ARB/ARNi, and beta-blockers remains a challenge.
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.
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