Guideline-Directed Medical Treatment (GDMT) of Heart Failure at Kauvery Hospitals: A clinical audit

Chandru B1, D. Suryaprabha2*

1Group Clinical Pharmacist, Kauvery Hospital, Cantonment, Trichy

2Assistant Manager-Clinical Research, Kauvery Hospitals, Trichy

*Correspondence: [email protected]

Background

Heart failure (HF) is a complex clinical syndrome that involves abnormalities in the structure or function of the heart, thereby reducing cardiac output and impairing the delivery of blood to metabolizing tissues. Patients with HF present to tertiary care with clinical features such as ankle swelling, shortness of breath and orthopnea.

Aim

Ample evidence now exists to prove that Guideline Directed Medical Treatment (GDMT) of Heart Failure (HF) reduces the mortality and morbidity of patients with heart failure during hospitalization, prevents their repeated hospitalizations and thus improves their quality of life

Methods and materials

This is an observational study, to evaluate the application of GDMT to patients with Heart Failure in Kauvery Hospitals.

A total of 100 patients, admitted over 1 year (November 2022 to October 2023) at various units of Kauvery Hospital were selected for the purposes of this audit to allow for a reasonable treatment initiation and up-titration period

Data Collection

Clinical pharmacists working in each hospital, identified by the respective investigators, were trained to collect relevant data of admissions with HF using a structured questionnaire. A standardized set of definitions for patient-related variables and clinical data were used.

Four Pillars of Heart failure Treatment

  • ACEs/ARBs/ Angiotensin Receptor-Neprilysin Inhibitors (ARNIs)
  • Cardio selective Beta Blockers
  • Mineralocorticoid Receptor Antagonists (MRA)
  • Sodium-Glucose Co-Transporter 2 (SGLT-2) inhibitors

Results and Discussion

1.  Demographic characteristics

Table 1: Demographic characteristics of study population

AgeCount%
20–401111
41–502828
51–603030
61–702424
71–8577

Graph 1: Age range of affected study population

2. Clinical characteristics

Table 2: Characteristics of study population

VariablesTotal (N = 100)
Age in years, mean (SD) 54.89 (11.87)
Congestive heart failure11
Mortality0
Chief complaints
Breathlessness52
Chest pain9
Miscellaneous39
History of hypertension, n (%)48 (48%)
History of diabetes, n (%)54 (54%)
History of CAD, n (%)43 (43%)
History of CKD, n (%)23 (23%)
History of Hypothyroidism (%)7 (7%)
NYHA Class III, IV. (%)65 (65%)
LVEF <40%, n (%)93 (93%)

Graph 2: Severity symptoms of heart failure in study population

3. Analysis of Evidenced based prescription for HFrEF patients

Table 3: Prescription percentage of evidenced based medications in the study population

MedicationsPercentage of Prescribed (%)
ARNI10
Beta blockers50
MRA51
Loop Diuretics78
SGLT2 Inhibitors22

Graph 3: Prescription percentage of evidenced based medications in the study population

Discussion

  • Heart failure poses severe healthcare challenges and affects economies of the families affected, and the countries where they are most prevalent. HF remains mostly unrecognized, and when recognized, inadequately treated.
  • The prevalence of HF is increasing exponentially and poses rising costs to healthcare systems. Heart Failure clinics, and hospitalization when required, helps to diagnose and treat early with GDMT. In Kauvery Hospitals, we organized an observational audit on the recognition of heart failure and its medical management by instituting GDMT.
  • In our study we followed 100 patients from various units of Kauvery Hospitals who were either diagnosed to have heart failure or were at risk of heart failure by analyzing their presentation, comorbidities and presence of HFrEF. We used NYHA (New York Heart Association) class to assess the severity of heart failure.
  • Most of the patients had breathlessness as the chief disability. Patients could be clinically identified as heart failure, or at risk of heart failure, with or without ischemia.
  • Benefits of the treatment are best realized with guideline-based therapy. SGLT2 Inhibitors have emerged as a promising cardio protective agent in patients with or without Diabetes and /or CKD. Even though, there was a majority of DM patients, only a few patients were prescribed with SGLT2 Inhibitors.
  • The prescription rate of ARNI was also low. Physician adherence to GDMT is limited. MRA prescription percentage was quite good but most patients received beta blockers and loop diuretics only.
  • There is an urgent need to offer GDMT to all eligible patients. There is no Mortality was recorded during this HF Study.

Conclusion

Hospitalization is a key location for initiation of guideline based HFrEF therapy. Lower prescription rate of GDMT indicates a reluctance to initiate and adhere to GDMT during hospitalization and through follow-up clinics. All patients with clinical diagnosis of heart failure merit guideline-based therapy to be in initiated at the earliest. It is possible to identify, investigate and manage patients with HF in the community. Physician’s adherence to the evidence based GDMT shall lead to a better outcome in the management of heart failure.

Chandru B
Group Clinical Pharmacist

Suryaprabha
Assistant Manager-Clinical Research

Journals

Kauvery Hospital
Find Doctor
Book Appointment