Physicians' Adherence To Guidelines On Medical Therapy For Heart Failure And Patients' Outcomes In A Kenyan Referral Hospital

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.