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Background <p>Heart failure is currently a major public health challenge worldwide, placing a significant burden on healthcare systems. Implementing guideline-directed medical therapies for heart failure with reduced ejection fraction is crucial to alleviating this burden; however, such practices are not optimally practiced in Ethiopia. Therefore, this study aimed to assess physicians’ adherence to guideline-directed therapy for heart failure with reduced ejection fraction at Tibebe Ghion Specialized Hospital, northwest Ethiopia.</p> Methods <p>An institution-based retrospective cross-sectional study design was employed among 278 adult patients with heart failure with reduced ejection fraction who were treated at Tibebe Ghion Specialized Hospital between December 1, 2023, to January 10, 2024. Data were extracted from patients’ medical records using a pre-developed checklist. Data entry was performed in EpiData version 3.1 and exported to SPSS version 25 for analysis. Descriptive statistics were computed, and an ordinal logistic regression model was used to evaluate the association between independent variables and the dependent variable.</p> Results <p>The mean age of the study participants was 58.4 ± 14 years, and 50.4% were male. The global class adherence score was categorized as good in 70.9% of patients, moderate in 21.6%, and poor in 8%. The proportion of patients who achieved the target dose was 25.5% for ACEIs, 7.6% for BBs, and 15.8% for MRAs. Longer duration of heart failure (AOR = 0.03, 95% CI: 1.01–1.06, <i>p</i> &lt; 0.023), cardiomyopathy as the underlying cause of heart failure (AOR = 3.02, 95% CI: 1.52–6.03, <i>p</i> &lt; 0.002), and lower baseline LVEF (AOR = 5.28, 95% CI: 2.39–11.68, <i>p</i> &lt; 0.001) were independent factors that increase physician’s guideline global class adherence.</p> Conclusion <p>Overall, physician adherence to guideline-directed medical therapy for patients with HFrEF in this study did not address the expected AHA and ESC recommendations. Only 70.5% of patients were prescribed all the indicated drugs. Underdosing of all guideline-directed medications was observed, especially the BB dose was very suboptimal.</p>

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Physician adherence to heart failure with reduced ejection fraction treatment guidelines: a cross-sectional study in Northwest Ethiopia

  • 期刊论文

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  • 发表日期：

    2025年11月10日

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  • Tilikalem Fenta Workineh,
  • Dejen Tsegaye Alem,
  • Ashagrie Sharew Iyassu,
  • Wubet Hunegnaw,
  • Bekele Getenet Tiruneh,
  • Tadele Fentabel Anagaw

摘要

Background

Heart failure is currently a major public health challenge worldwide, placing a significant burden on healthcare systems. Implementing guideline-directed medical therapies for heart failure with reduced ejection fraction is crucial to alleviating this burden; however, such practices are not optimally practiced in Ethiopia. Therefore, this study aimed to assess physicians’ adherence to guideline-directed therapy for heart failure with reduced ejection fraction at Tibebe Ghion Specialized Hospital, northwest Ethiopia.

Methods

An institution-based retrospective cross-sectional study design was employed among 278 adult patients with heart failure with reduced ejection fraction who were treated at Tibebe Ghion Specialized Hospital between December 1, 2023, to January 10, 2024. Data were extracted from patients’ medical records using a pre-developed checklist. Data entry was performed in EpiData version 3.1 and exported to SPSS version 25 for analysis. Descriptive statistics were computed, and an ordinal logistic regression model was used to evaluate the association between independent variables and the dependent variable.

Results

The mean age of the study participants was 58.4 ± 14 years, and 50.4% were male. The global class adherence score was categorized as good in 70.9% of patients, moderate in 21.6%, and poor in 8%. The proportion of patients who achieved the target dose was 25.5% for ACEIs, 7.6% for BBs, and 15.8% for MRAs. Longer duration of heart failure (AOR = 0.03, 95% CI: 1.01–1.06, p < 0.023), cardiomyopathy as the underlying cause of heart failure (AOR = 3.02, 95% CI: 1.52–6.03, p < 0.002), and lower baseline LVEF (AOR = 5.28, 95% CI: 2.39–11.68, p < 0.001) were independent factors that increase physician’s guideline global class adherence.

Conclusion

Overall, physician adherence to guideline-directed medical therapy for patients with HFrEF in this study did not address the expected AHA and ESC recommendations. Only 70.5% of patients were prescribed all the indicated drugs. Underdosing of all guideline-directed medications was observed, especially the BB dose was very suboptimal.