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How guideline directed medical therapy (GDMT) is practiced for heart failure patients? A cross- sectional study in YAZD-IRAN


avatar fatemeh baridloghmani 1 , avatar Fatemeh Dana 1 , avatar Ahmad shajari 1 , avatar Elahe Zare 2 , avatar mohammadhossein soltani ORCID 2 , *

1 Ali-ebne-Abitaleb School of Medicine, Islamic Azad University, Yazd, IR Iran

2 Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, IR Iran

How to Cite: baridloghmani F, Dana F, shajari A, Zare E, soltani M. How guideline directed medical therapy (GDMT) is practiced for heart failure patients? A cross- sectional study in YAZD-IRAN. Int Cardio Res J. 2021;15(4):e119179.


International Cardiovascular Research Journal: 15 (4); e119179
Published Online: December 31, 2021
Article Type: Research Article
Received: August 29, 2021
Revised: December 08, 2021
Accepted: December 21, 2021


Background: In Heart Failure reduced Ejection Fraction (HFrEF), there is a clear
Guideline Directed Medical Therapy (GDMT) for drug treatment. However, there are
usually differences between what is recommended and what is actually done in the
community. Additionally, no clear data are available regarding the types and doses of
drugs used for HFrEF in patients with chronic heart failure.
Objectives: The present study aimed to investigate the current drug treatment for HFrEF
in the community.
Methods: This cross-sectional study aimed to investigate the types and doses of drugs
used by cardiologists for HFrEF patients. The data were collected using a researchermade
questionnaire by attending cardiologists’ offices and reviewing patients’ drugs.
Considering the probability of 20% of patients using optimal drug doses (according to a
pilot study), the sample size was estimated as 250 patients. Thus, 300 patients with stable
drug regimens for three months were enrolled into the study.
Results: The mean age of the patients was 62.3 ± 14 years and 65% were male. The mean
Left Ventricular Ejection Fraction (LVEF) was 27.3 ± 7%. Additionally, the rates of using
Beta Blockers (BBs), Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptor
Blockers (ACEIs/ARBs), and Mineralocorticoid Receptor Antagonists (MRAs) were
91%, 89%, and 63%, respectively. Only 5% of the patients received the target dose of BBs
and 11% took the target dose of ACEs/ARBs. A significant gap was discerned between the
recommended target doses and the patients’ current doses.
Conclusion: The frequency of consumption of BBs, ACEs/ARBs, and MRAs in HFrEF
was reasonably acceptable in the study population. However, there was a marked
difference between the recommended and actual drug doses for HFrEF. Hence, further
studies are required to evaluate and resolve the barriers.


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    The references are available in pdf.

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