Adherence to Guideline Directed Medical Therapy in Heart Failure Patients in a Tertiary Hospital in Southern Nigeria: A Real-World Experience

Dodiyi-Manuel Sotonye; Ajala Aisha Oluwabunmi

doi:doi:10.11648/j.ejpm.20231102.11

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Adherence to Guideline Directed Medical Therapy in Heart Failure Patients in a Tertiary Hospital in Southern Nigeria: A Real-World Experience

Dodiyi-Manuel Sotonye, Ajala Aisha Oluwabunmi

Published in European Journal of Preventive Medicine (Volume 11, Issue 2)

Received: 22 March 2023 Accepted: 31 March 2023 Published: 20 April 2023

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Abstract

Background: There is an increase in the incidence of heart failure among the sub-Saharan population. The use of guideline-directed medical therapy has been shown not only to reduce disease progression but also frequent hospitalization, morbidity, and mortality from heart failure. This study was directed at identifying which of the major drug class for treatment of heart failure was incorporated by the physicians in the area. Methodology: The study involved collection of data from patient’s records using an observational checklist. A total of 166 heart failure patients with reduced EF were recruited between the age ranges of 33 and 95 years. The medications prescribed, date of drug initiation and progress in optimization of therapy were assessed over a 1-year period and data analyzed using SPSS version 25. A p-value of 0.05 and below was considered statistically significant. Results: The result showed that the most prevalent causes of heart failure were hypertensive heart disease (70.5%), followed by dilated cardiomyopathy (15.7%) and valvular heart disease (6.6%). The use of diuretics was prevalent among study cohorts at 87.4%, followed by Mineralocorticoid antagonist (MRAs) (78.3%), ARB/ACEI/ARNI (68.1%), beta blockers (40.4%), and less than a third of patients were on SGLT2 inhibitors (28.9%). The dosing of heart failure medications was noticed to be fixed without up-titration of doses at intervals for most classes of GDMT except the MRAs. Only about 2.4% of the study cohorts had dose optimization over this period and most study patients were not on optimal maximal doses of heart failure therapy. Conclusion: The use of guideline directed medical therapy has improved amongst HF patients however up titration of doses remains a major problem amongst patients managed in our clinic. The implementation of a multi-disciplinary HF clinic focused on improvement of outcomes of HF patient is essential in improving not only the use of Guideline- directed medical therapy (GDMT) but up-titration to optimal doses for maximal benefits.

Published in	European Journal of Preventive Medicine (Volume 11, Issue 2)
DOI	10.11648/j.ejpm.20231102.11
Page(s)	16-20
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2023. Published by Science Publishing Group

Keywords

GDMT, Medication, Heart Failure, Optimization, Dosing

References

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[2]	Ahmed A, Aronow WS, Fleg JL. Higher New York Heart Association classes and increased mortality and hospitalization in patients with heart failure and preserved left ventricular function. Am Heart J. 2006; 151: 444–450.
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[4]	Heidenreich PA, Bozkurt B, Aguilar D, Allen LA, Byun JJ, Yancy CW et al 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022; 145: e895–e1032.
[5]	Ezekowitz JA, McAlister FA. Aldosterone blockade and left ventricular dysfunction: a systematic review of randomized clinical trials. Eur Heart J. 2009; 30: 469–477.
[6]	Konstam MA, Neaton JD, Dickstein K, et al. HEAAL Investigators. Effects of high-dose versus low-dose losartan on clinical outcomes in patients with heart failure (HEAAL study): a randomised, double-blind trial. Lancet. 2009; 374: 1840–1848.
[7]	Straw S, McGinlay M, Witte KK. Four pillars of heart failure: contemporary pharmacological therapy for heart failure with reduced ejection fraction. 2021; 2021- 001585.
[8]	McDonagh TA. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 42 (36): 3599–3726.
[9]	McMurray JV, Solomon SD, Inzucchi SE, Køber L, Kosiborod MN, DAPA-HF Trial Committees and Investigators. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med 2019; 381: 1995-2008.
[10]	Cowie MR et al. Patient factors associated with titration of medical therapy in patients with heart failure with reduced ejection fraction: data from the QUALIFY international registry. ESC Heart Fail. 2021; 8 (2): 861–871.
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[13]	Negi PC, Kandoria A, Asotra S, Ganju KN, Merwaha R, Sharma R et al. Gender differences in the epidemiology of Rheumatic Fever/Rheumatic heart disease (RF/RHD) patient population of hill state of northern India; 9 years prospective hospital based, HP-RHD registry. Indian Heart Journal. 2020; 72 (6): 552-556.
[14]	Joseph, J., P S, S., James, J. et al. Guideline-directed medical therapy in heart failure patients: impact of focused care provided by a heart failure clinic in comparison to general cardiology out-patient department. Egypt Heart J 72, 53 (2020).
[15]	2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). European Heart Journal (2021) 42, 3599 – 3726.
[16]	Chen X, Cui X, Thunström E, Pivodic A, Dahlström U, Fu M. Guideline-directed medical therapy in real-world heart failure patients with low blood pressure and renal dysfunction. Clin Res Cardiol. 2021 Jul; 110 (7): 1051-1062.
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[18]	Kennelly P, Sapkota R, Azhar M, Cheema FH, Conway C, Hameed A. Diuretic therapy in congestive heart failure. Acta Cardiol. 2022 Apr; 77 (2): 97-104.

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APA Style

Dodiyi-Manuel Sotonye, Ajala Aisha Oluwabunmi. (2023). Adherence to Guideline Directed Medical Therapy in Heart Failure Patients in a Tertiary Hospital in Southern Nigeria: A Real-World Experience. European Journal of Preventive Medicine, 11(2), 16-20. https://doi.org/10.11648/j.ejpm.20231102.11

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ACS Style

Dodiyi-Manuel Sotonye; Ajala Aisha Oluwabunmi. Adherence to Guideline Directed Medical Therapy in Heart Failure Patients in a Tertiary Hospital in Southern Nigeria: A Real-World Experience. Eur. J. Prev. Med. 2023, 11(2), 16-20. doi: 10.11648/j.ejpm.20231102.11

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AMA Style

Dodiyi-Manuel Sotonye, Ajala Aisha Oluwabunmi. Adherence to Guideline Directed Medical Therapy in Heart Failure Patients in a Tertiary Hospital in Southern Nigeria: A Real-World Experience. Eur J Prev Med. 2023;11(2):16-20. doi: 10.11648/j.ejpm.20231102.11

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@article{10.11648/j.ejpm.20231102.11,
  author = {Dodiyi-Manuel Sotonye and Ajala Aisha Oluwabunmi},
  title = {Adherence to Guideline Directed Medical Therapy in Heart Failure Patients in a Tertiary Hospital in Southern Nigeria: A Real-World Experience},
  journal = {European Journal of Preventive Medicine},
  volume = {11},
  number = {2},
  pages = {16-20},
  doi = {10.11648/j.ejpm.20231102.11},
  url = {https://doi.org/10.11648/j.ejpm.20231102.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejpm.20231102.11},
  abstract = {Background: There is an increase in the incidence of heart failure among the sub-Saharan population. The use of guideline-directed medical therapy has been shown not only to reduce disease progression but also frequent hospitalization, morbidity, and mortality from heart failure. This study was directed at identifying which of the major drug class for treatment of heart failure was incorporated by the physicians in the area. Methodology: The study involved collection of data from patient’s records using an observational checklist. A total of 166 heart failure patients with reduced EF were recruited between the age ranges of 33 and 95 years. The medications prescribed, date of drug initiation and progress in optimization of therapy were assessed over a 1-year period and data analyzed using SPSS version 25. A p-value of 0.05 and below was considered statistically significant. Results: The result showed that the most prevalent causes of heart failure were hypertensive heart disease (70.5%), followed by dilated cardiomyopathy (15.7%) and valvular heart disease (6.6%). The use of diuretics was prevalent among study cohorts at 87.4%, followed by Mineralocorticoid antagonist (MRAs) (78.3%), ARB/ACEI/ARNI (68.1%), beta blockers (40.4%), and less than a third of patients were on SGLT2 inhibitors (28.9%). The dosing of heart failure medications was noticed to be fixed without up-titration of doses at intervals for most classes of GDMT except the MRAs. Only about 2.4% of the study cohorts had dose optimization over this period and most study patients were not on optimal maximal doses of heart failure therapy. Conclusion: The use of guideline directed medical therapy has improved amongst HF patients however up titration of doses remains a major problem amongst patients managed in our clinic. The implementation of a multi-disciplinary HF clinic focused on improvement of outcomes of HF patient is essential in improving not only the use of Guideline- directed medical therapy (GDMT) but up-titration to optimal doses for maximal benefits.},
 year = {2023}
}

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TY  - JOUR
T1  - Adherence to Guideline Directed Medical Therapy in Heart Failure Patients in a Tertiary Hospital in Southern Nigeria: A Real-World Experience
AU  - Dodiyi-Manuel Sotonye
AU  - Ajala Aisha Oluwabunmi
Y1  - 2023/04/20
PY  - 2023
N1  - https://doi.org/10.11648/j.ejpm.20231102.11
DO  - 10.11648/j.ejpm.20231102.11
T2  - European Journal of Preventive Medicine
JF  - European Journal of Preventive Medicine
JO  - European Journal of Preventive Medicine
SP  - 16
EP  - 20
PB  - Science Publishing Group
SN  - 2330-8230
UR  - https://doi.org/10.11648/j.ejpm.20231102.11
AB  - Background: There is an increase in the incidence of heart failure among the sub-Saharan population. The use of guideline-directed medical therapy has been shown not only to reduce disease progression but also frequent hospitalization, morbidity, and mortality from heart failure. This study was directed at identifying which of the major drug class for treatment of heart failure was incorporated by the physicians in the area. Methodology: The study involved collection of data from patient’s records using an observational checklist. A total of 166 heart failure patients with reduced EF were recruited between the age ranges of 33 and 95 years. The medications prescribed, date of drug initiation and progress in optimization of therapy were assessed over a 1-year period and data analyzed using SPSS version 25. A p-value of 0.05 and below was considered statistically significant. Results: The result showed that the most prevalent causes of heart failure were hypertensive heart disease (70.5%), followed by dilated cardiomyopathy (15.7%) and valvular heart disease (6.6%). The use of diuretics was prevalent among study cohorts at 87.4%, followed by Mineralocorticoid antagonist (MRAs) (78.3%), ARB/ACEI/ARNI (68.1%), beta blockers (40.4%), and less than a third of patients were on SGLT2 inhibitors (28.9%). The dosing of heart failure medications was noticed to be fixed without up-titration of doses at intervals for most classes of GDMT except the MRAs. Only about 2.4% of the study cohorts had dose optimization over this period and most study patients were not on optimal maximal doses of heart failure therapy. Conclusion: The use of guideline directed medical therapy has improved amongst HF patients however up titration of doses remains a major problem amongst patients managed in our clinic. The implementation of a multi-disciplinary HF clinic focused on improvement of outcomes of HF patient is essential in improving not only the use of Guideline- directed medical therapy (GDMT) but up-titration to optimal doses for maximal benefits.
VL  - 11
IS  - 2
ER  -

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Author Information

Dodiyi-Manuel Sotonye

Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port-Harcourt, Nigeria
Ajala Aisha Oluwabunmi

Department of Internal Medicine, University of Port Harcourt Teaching Hospital, Port-Harcourt, Nigeria

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APA Style

Dodiyi-Manuel Sotonye, Ajala Aisha Oluwabunmi. (2023). Adherence to Guideline Directed Medical Therapy in Heart Failure Patients in a Tertiary Hospital in Southern Nigeria: A Real-World Experience. European Journal of Preventive Medicine, 11(2), 16-20. https://doi.org/10.11648/j.ejpm.20231102.11

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ACS Style

Dodiyi-Manuel Sotonye; Ajala Aisha Oluwabunmi. Adherence to Guideline Directed Medical Therapy in Heart Failure Patients in a Tertiary Hospital in Southern Nigeria: A Real-World Experience. Eur. J. Prev. Med. 2023, 11(2), 16-20. doi: 10.11648/j.ejpm.20231102.11

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AMA Style

Dodiyi-Manuel Sotonye, Ajala Aisha Oluwabunmi. Adherence to Guideline Directed Medical Therapy in Heart Failure Patients in a Tertiary Hospital in Southern Nigeria: A Real-World Experience. Eur J Prev Med. 2023;11(2):16-20. doi: 10.11648/j.ejpm.20231102.11

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@article{10.11648/j.ejpm.20231102.11,
  author = {Dodiyi-Manuel Sotonye and Ajala Aisha Oluwabunmi},
  title = {Adherence to Guideline Directed Medical Therapy in Heart Failure Patients in a Tertiary Hospital in Southern Nigeria: A Real-World Experience},
  journal = {European Journal of Preventive Medicine},
  volume = {11},
  number = {2},
  pages = {16-20},
  doi = {10.11648/j.ejpm.20231102.11},
  url = {https://doi.org/10.11648/j.ejpm.20231102.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ejpm.20231102.11},
  abstract = {Background: There is an increase in the incidence of heart failure among the sub-Saharan population. The use of guideline-directed medical therapy has been shown not only to reduce disease progression but also frequent hospitalization, morbidity, and mortality from heart failure. This study was directed at identifying which of the major drug class for treatment of heart failure was incorporated by the physicians in the area. Methodology: The study involved collection of data from patient’s records using an observational checklist. A total of 166 heart failure patients with reduced EF were recruited between the age ranges of 33 and 95 years. The medications prescribed, date of drug initiation and progress in optimization of therapy were assessed over a 1-year period and data analyzed using SPSS version 25. A p-value of 0.05 and below was considered statistically significant. Results: The result showed that the most prevalent causes of heart failure were hypertensive heart disease (70.5%), followed by dilated cardiomyopathy (15.7%) and valvular heart disease (6.6%). The use of diuretics was prevalent among study cohorts at 87.4%, followed by Mineralocorticoid antagonist (MRAs) (78.3%), ARB/ACEI/ARNI (68.1%), beta blockers (40.4%), and less than a third of patients were on SGLT2 inhibitors (28.9%). The dosing of heart failure medications was noticed to be fixed without up-titration of doses at intervals for most classes of GDMT except the MRAs. Only about 2.4% of the study cohorts had dose optimization over this period and most study patients were not on optimal maximal doses of heart failure therapy. Conclusion: The use of guideline directed medical therapy has improved amongst HF patients however up titration of doses remains a major problem amongst patients managed in our clinic. The implementation of a multi-disciplinary HF clinic focused on improvement of outcomes of HF patient is essential in improving not only the use of Guideline- directed medical therapy (GDMT) but up-titration to optimal doses for maximal benefits.},
 year = {2023}
}

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TY  - JOUR
T1  - Adherence to Guideline Directed Medical Therapy in Heart Failure Patients in a Tertiary Hospital in Southern Nigeria: A Real-World Experience
AU  - Dodiyi-Manuel Sotonye
AU  - Ajala Aisha Oluwabunmi
Y1  - 2023/04/20
PY  - 2023
N1  - https://doi.org/10.11648/j.ejpm.20231102.11
DO  - 10.11648/j.ejpm.20231102.11
T2  - European Journal of Preventive Medicine
JF  - European Journal of Preventive Medicine
JO  - European Journal of Preventive Medicine
SP  - 16
EP  - 20
PB  - Science Publishing Group
SN  - 2330-8230
UR  - https://doi.org/10.11648/j.ejpm.20231102.11
AB  - Background: There is an increase in the incidence of heart failure among the sub-Saharan population. The use of guideline-directed medical therapy has been shown not only to reduce disease progression but also frequent hospitalization, morbidity, and mortality from heart failure. This study was directed at identifying which of the major drug class for treatment of heart failure was incorporated by the physicians in the area. Methodology: The study involved collection of data from patient’s records using an observational checklist. A total of 166 heart failure patients with reduced EF were recruited between the age ranges of 33 and 95 years. The medications prescribed, date of drug initiation and progress in optimization of therapy were assessed over a 1-year period and data analyzed using SPSS version 25. A p-value of 0.05 and below was considered statistically significant. Results: The result showed that the most prevalent causes of heart failure were hypertensive heart disease (70.5%), followed by dilated cardiomyopathy (15.7%) and valvular heart disease (6.6%). The use of diuretics was prevalent among study cohorts at 87.4%, followed by Mineralocorticoid antagonist (MRAs) (78.3%), ARB/ACEI/ARNI (68.1%), beta blockers (40.4%), and less than a third of patients were on SGLT2 inhibitors (28.9%). The dosing of heart failure medications was noticed to be fixed without up-titration of doses at intervals for most classes of GDMT except the MRAs. Only about 2.4% of the study cohorts had dose optimization over this period and most study patients were not on optimal maximal doses of heart failure therapy. Conclusion: The use of guideline directed medical therapy has improved amongst HF patients however up titration of doses remains a major problem amongst patients managed in our clinic. The implementation of a multi-disciplinary HF clinic focused on improvement of outcomes of HF patient is essential in improving not only the use of Guideline- directed medical therapy (GDMT) but up-titration to optimal doses for maximal benefits.
VL  - 11
IS  - 2
ER  -

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