Physicians’ Adherence to Guidelines on Medical Therapy for Heart Failure and Patients’ Outcomes in a Kenyan Referral Hospital

Abstract

BackgroundAdherence to guidelines on prescription and uptitration of GDMT for HFrEF is associated with reduced mortality and hospitalization. Published data on physicians’ GDMT prescription in sub-Saharan Africa is scarce. In addition, there is a need for data on patients’ characteristics, treatment, and outcomes in this region.ObjectiveTo determine physicians’ level of adherence to guidelines on prescription and uptitration of medical therapy for HFrEF at AKUHN, a referral hospital in Nairobi, Kenya.MethodsWe reviewed 280 files of all HFrEF patients admitted over a 3-year period. Detailed patients’ characteristics and outcomes were analyzed. We calculated the Guideline Adherence Index (GAI) and the QUality of Adherence to guideline recommendations for LIFe-saving treatment in heart failure (QUALIFY) scores. From worst to best, GAI ranges from 0 to 100%, while QUALIFY scores were categorized as poor, moderate, or good.ResultsThe median age (IQR) was 63 years (53,74); 165(58.9%) were male; and 207(74.2%) were black; 98(35%) had ischemic heart disease; 153(54.6%) had hypertension, and 101(36.1%) had diabetes. At six months follow-up, 43.8% of patients had been readmitted at least once and 8.8% had died. GAI at discharge were 66.2%, 71.7%, and 42.6% for ACEI/ARNI/ARBs, B-blockers, and MRAs, respectively. At 6 months, the scores were 86.3%, 84.4%, and 61.2%, respectively. GAI for SGLT2is was 38.9% at 6 months. The proportions for good QUALIFY scores for ACEI/ARNI/ARBs, B- blockers, and MRAs were 35.8%, 38.5%, and 9.5%, respectively. Uptitration to ≥ 50% of target dose was done in 51.9%, 48.7%, and 7.9% of patients for ACEI/ARNI/ARBs, B- blockers, and MRAs, respectively.ConclusionPhysicians’ level of adherence to prescription and up-titration of GDMT was satisfactory for ACEI/ARNI/ARBs and B-blockers, however, it was poor for SGLT2is and MRAs. There is a need for regular surveys on prescription and uptitration of GDMT with a special attention to MRAs and SGLT2is.