Evaluation of the Practice of adherence to Guideline-directed medical therapy and its associated factors among Heart failure patients with reduced ejection fraction at the ambulatory clinic of the University of Gondar Comprehensive Specialized Hospital, Northwest, Ethiopia, 2023: A mixed study approach

Abstract

Background: Good adherence to guidline directed medical therapy (GDMT) is vital to improving the treatment outcome in heart failure patients with reduced ejection fraction. Objective: To evaluate the practice of adherence to GDMT and its associated factors among heart failure patients with reduced ejection fraction (HFrEF) at the ambulatory clinic of University of Gondar Comprehensive Specialized Hospital. Method: A hospital-based retrospective follow-up study and key informative interviews were conducted, and the medical record of 420 heart failure patients with reduced ejection fraction from September 1, 2018, to July 31, 2023, was reviewed. The practice of adherence to GDMT was evaluated by QUALIFY scores. SPSS V.27.0 was used for analysis. A multinomial logistic regression analysis was used to examine the association between practice of adherence to GDMT and its associated factors. Additionally, thematic analysis was done for qualitative data. Result: The QUALIFY scores showed that the practice of adherence to GDMT was good in 40% [95% CI (35.30–44.90)], moderate in 33.8% [95% CI (29.3–38.6)], and poor in 26.2% [95% CI (22–30.7)] of the study patients. Age ≥ 65 [AOR: 0.14; 95% CI (0.07–0.29)], cause of HF specifically IHD [AOR: 16; 95% CI (6.75–37.90)], VHD [AOR: 5.3; 95% CI (2.58–10.92)], dCMP [AOR: 8.24; 95% CI (3.97–17.09)], and HTN [AOR: 6.62; 95% CI (2.98–14.69)], duration of HFrEF ≥ 3 years [AOR: 2.59; 95% CI (1.32–5.08)] were factors significantly associated with good practice adherence to GDMT. Additionally, four themes (knowledge about the GDMT for the management of heart failure patients with reduced ejection fraction, dose optimization practice, reasons and challenges, and solutions and recommendations) were identified in the qualitative data analysis. Conclusion: The use of all indicated medications as per the guideline recommendation for HFrEF was low, and the majority of patients received suboptimal doses of guidline directed medical therapy. Particularly, the BBs dose was very suboptimal. Additionally, the qualitative study showed that physicians’ awareness of guideline recommendations for the management of HFrEF was low. We advised encouraging training for healthcare providers, availing of separate cardiac clinics and cardiologist, following guidelines, scheduling appointments for patients on time, and availing of medications are mandatory for good practice adherence to GDMT for better clinical outcomes.