Monthly Heart Failure audit report on GDMT in Heart city, January 2025

Vignesh. R1, Dharsshini. N2

1Clinical Pharmacist, Kauvery Hospital, Heart City, Trichy

2Group Clinical Pharmacist, Kauvery Hospitals, Trichy

Background

Heart failure (HF) remains a significant global health challenge, affecting millions of individuals worldwide and imposing substantial burdens on healthcare systems. Despite advances in therapeutic strategies, HF continues to be associated with high rates of morbidity, mortality, and hospitalizations, making it a leading cause of cardiovascular-related deaths globally

Guideline-directed medical therapy (GDMT) plays a pivotal role in the management of HF, aiming to alleviate symptoms, improve quality of life, and reduce adverse outcomes

The follow up study of Heart failure in Heart City has been done for the month of January 2025.  Data were collected and interpreted. The study includes 33 patients with heart failure.

The significance of findings was tested.

Report

Graph 1: Age and Sex category of HF patients in Heart city for the month of January 2025

Table 1: ECHO findings of HF patients in Heart city

ECHO (EF%) n=33Percentage (100%)
Severe LV Dysfunction21 (63.6%))
Moderate to Severe LV Dysfunction 1 (3%)
Moderate LV Dysfunction11 (33.3%)

Table 2: Past medical history of HF patients in Heart city for the month of January 2025

Past Medical History Percentage 33(100%)
Only Diabetes 9 (27%)
Only Hypertension 4 (12%)
DM & HTN11 (33.3%)
T2DM, Hypothyroidism, Dyslipidemia1 (3%)
No History 8 (24%)

Table 3: Complaints of HF patients in Heart city for the month of January 2025

ComplaintsPercentage 33 (100%)
Breathlessness 8 (24.2%)
Chest pain 17 (51.5%)
Abdominal Pain1 (3%)
Chest pain & Breathing Difficulty7 (21%)

Graph 2: Medication therapy of HF patients during admission in Heart city for the month of January 2025

15 % (n = 5) of patients did not receive any Guideline Directed Medical Treatment. 58% of patients received Diuretics. 39% of patients received Mineralocorticoid receptor blockers. All four GDMT drugs were not received by any patient.

Graph 3:  Comparison of GDMT drugs between Dec 2024 & Jan 2025

Discussion

This study highlights the status of Guideline Directed Medical Treatment offered to the study population attending inpatient at kauvery hospital, heart city.

  • The main outcomes assessed was the proportion of eligible patients who received GDMT during their hospitalization.
  • Maximum number of male patients (27%) was in the age group of 51-60. Maximum number of female patient (18%) was in the age group of 61-70.
  • 21(64%) of patients had Severe LV Dysfunction. Diabetes and Hypertension were the most common co – morbidities and risk factors among our population.
  • Most patients were on a loop diuretic. GDMT (SGLT2I, ARNI, MRA & Cardio selective beta blocker) drugs were of low proportion. Not all four drugs were received by any patient.
  • From our study, it is observed that there is a very low rate of offer of GDMT to eligible patients.
  • On comparison between December 2024 & January 2025 (Graph 6), the number of GDMT drugs received by the patient had not statistically increased. It is seen that up to 5 patients did not received any GDMT drugs on January 2025. The count was 3 in the month of December 2024.

Importance of GDMT

  • GDMT represents the most up-to-date and evidence-based approach to managing Heart Failure, whether HFrEF or HFpEF, and offering to eligible patients indicates that patients are receiving therapies proven to be effective in improving outcomes and reducing morbidity and mortality in Heart Failure
  • By addressing various aspects of disease progression, such as neurohormonal activation, endothelial dysfunction, inflammation, and ventricular remodeling, GDMT helps optimize disease management and improve patient outcomes.
  • GDMT has been shown to reduce the risk of cardiovascular events, including heart failure exacerbations, myocardial infarction, stroke, and cardiovascular death.
  • GDMT aims not only to manage symptoms but also to slow or halt the progression of cardiovascular diseases. By targeting key pathophysiological processes involved in disease progression, such as myocardial remodeling, fibrosis, and atherosclerosis, GDMT helps prevent further deterioration of cardiac function and structural abnormalities.
  • Begun early, GDMT reverses myocardial remodeling

Conclusion

In conclusion, conducting an audit focusing on guideline-directed medical therapy (GDMT) in heart failure (HF) management is essential for assessing adherence to evidence-based guidelines and optimizing patient care. Continued efforts to monitor and evaluate GDMT utilization through audits are critical for advancing evidence-based practice and achieving optimal outcomes in HF care.

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