Evaluation of prescribing adherence to guideline-directed medical therapy in patients with chronic heart failure: a retrospective study at the National Heart Centre in Oman.

BACKGROUND

Guideline-directed medical therapy (GDMT) improves survival and quality of life in patients with heart failure with reduced ejection fraction (HFrEF). However, real-world adherence to these guidelines remains suboptimal. This study aimed to evaluate prescribing adherence to GDMT in HFrEF patients using a global guideline adherence scoring tool.

METHODS

This retrospective study included adult patients with HFrEF (left ventricular ejection fraction ≤ 40%) attending the Heart Failure Clinic at the National Heart Centre in Oman between January and June 2022. GDMT adherence was assessed based on 2021 European Society of Cardiology guidelines. Adherence levels were categorized as good (all indicated GDMT at ≥ 50% of target dose), moderate (more than half at ≥ 50%), or poor (less than half or < 50%). Descriptive statistics and chi-square tests were used to identify associations.

RESULTS

Of the 259 patients included (mean age 57 ± 13.6 years, 70% male), 71% had good adherence, 22% moderate, and 7% poor. Target dose attainment varied by drug class: 78% for beta-blockers, 63% for ACEI/ARB/ARNI, 96% for MRAs, and 100% for ivabradine. Suboptimal GDMT (< 50% target dose) was significantly associated with hypertension (P = 0.004), dilated cardiomyopathy (P = 0.015), chronic kidney disease (P = 0.001), and older age (P = 0.004).

CONCLUSION

Prescribing adherence to GDMT in Oman is consistent with international data. Suboptimal titration was significantly linked to older age and comorbidities, suggesting that perceived frailty and clinical complexity may influence physician prescribing patterns. Efforts to improve individualized, patient-centered GDMT titration are warranted.