How Guideline Directed Medical Therapy Is Practiced for Patients with Heart Failure? A Cross-Sectional Study in Yazd, Iran

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 researcher-made 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.