Assessment of Physicians’ Adherence to Guideline recommended Medications and Associated factors in Patients with Heart Failure With reduced Ejection fraction in Ambo town Public Hospitals, West Showa Zone, Ethiopia, 2024: A Cross-Sectional Study

Abstract

Introduction: Heart failure is a burden for the health care system affecting 64.3 million people globally. There is clear evidence from landmark studies that optimal uses of Angiotensin converting Enzyme inhibitors ,Angiotensin receptor blockers, Beta blockers and Mineralocorticoid receptor antagonists to achieve target dose used in Randomized Clinical trials improves survival and reduce morbidity in patients with Heart failure with reduced ejection fraction. Objective: To assess physicians adherence to guideline recommended medical therapy and associated factors among patients with Heart failure with reduced ejection fraction in Ambo town public hospitals, west-showa zone , Ambo, Ethiopia. Methods: A Crosss-sectional study was conducted and the medial records of 195 HFrEF patients with follow up at Ambo town public hospitals form December1, 2023 to January 30, 2024 was reviewed. Global class of adherence score (GCA) was used to evaluate the use of BB, ACEI/ARB and MRA according to the international guideline by physicians. IBM SPSS 27 software was used for data analysis. A multivariate Logistic regression model was used to calculate adjusted odd ratios (ORs). Adjusted OR was used to assess association between dependent and independent variables with 95% confidence interval (CI) a P value of < 0.05. Categorical data were analysed as frequencies with percentages and continuous data were analysed as means with standard deviations. Results: GCA score among physicians was good in 44.1%, Moderate in 45.1% and Poor in 10.8% of the study patients. GCA for individual drugs was 87.7% for BB, 93.8% for ACEI/ARB and 44.1% for MRA. The proportion of patients at target dose (100%) was 0.6% for BB , 6.0% for ACEI/ARB and 1.2% for MRA. Multivariable logistic regression was done for age ≥65 years (AOR=2.751, 95%CI= 0.990-7.644, P=0.052),duration of heart failure ≥5 years (AOR= 3.857 95%CI = 0.839-17.733, P=0.083),Atrial fibrillation (AOR=0.368, 95%CI= 0.099-1.374, P=0.137), DM (AOR=2.697, 95%CI= 0.928-7.842, P=0.068) and Pulmonary HTN (AOR=0.276, 95%CI=0.035-2.214, P=0.226). V Conclusion and Recommendations: In this study, the use of all the three GDMT as per the guideline recommendation for physicians was low and the dose of individual drugs was sub-optimal, especially, Beta blockers. None of the independent variables had significant association with the physicians’ adherence to GDMT. Physicians’ shall prescribe all GDMT for patients with HFrEF and titrate-up to maximum tolerated dose