Patterns of utilization and optimization of guideline-directed medical therapy and associated factors among heart failure patients with reduced ejection fraction in selected hospitals of Addis Ababa, Ethiopia: a cross-sectional study

Abstract

Background The global burden of heart failure, especially with reduced ejection fraction, is a significant health issue. Current guidelines stress the importance of optimal medication use to maximize patient outcomes. Nevertheless, a notable gap exists in implementing these guidelines worldwide. In Ethiopia, there is limited post-guideline data on the utilization and optimization of medications for patients with heart failure and reduced ejection fraction. This study aims to evaluate the patterns of utilization and drug optimization and associated factors of guideline directed medical therapy among these patients attending cardiac centers at selected public and private hospitals, Addis Ababa, Ethiopia. Methods A facility-based, cross-sectional study was conducted. Data were collected using a pretested, structured checklist. Data were edited and cleaned via Microsoft Excel 2016 and analyzed using SPSS version 26. Baseline demographic and clinical datawere summarized using descriptive statistics. Multiple logistic regression analysis was run to identify association between dependent and independent variables, by computing odds ratio and 95% confidence interval. A p-value < 0.05 was considered significant. Results A total of 404 patients were included in this study, with a response rate of 95.7%. Majority (222; 55%) were males, and patients’ age ranged from 17 years to 86 years with a median (inter-quartile range) of 56 (43.25–65) years. Overall, 46 (11.4%) were receiving quadruple therapy. ACEIs/ARBs, beta-blockers and MRA were given to 212(52.5%), 314 (77.7%), and238 (58.9%) patients, respectively. SGLT2Is were prescribed to only 109 (27%) patients. Age older than 65 years (AOR = 4.34; 95% CI = 1.59, 11.89), history of previous hospitalization (AOR = 2.50; 95% CI = 1.21, 5.15) and taking < 5 medications (AOR = 9.6; 95% CI = 2.79, 33.07) were associated with GDMT underutilization. Conclusion There is a large gap in GDMT implementation, with majority of the patients having either underutilization or under-dosing, particularly those older than 65 years, with history of previous hospitalization and taking < 5 medications. Thus, efforts should be directed to design customized guidelines along with institution of sensitization and training programs while also considering multidisciplinary care.