Utilization of mineralocorticoid receptor antagonists within guideline-directed medical therapy for patients with heart failure and reduced ejection fraction at Wallaga University Comprehensive Specialized Hospital: a hospital-based retrospective study

Abstract

Despite the advancements of therapy and prevention, heart failure continues to be a major cause of morbidity and mortality worldwide. Appropriate use of Guideline Directed Medical Therapy has been proved to improve the clinical outcome of patients with heart failure with reduced ejection fraction. Nonetheless, there is a gap in the implementation of guideline-directed medical therapy for the management of heart failure globally. Particularly, data on the use of Guideline Directed Medical Therapy are scarce in developing countries, particularly in Ethiopia. Hence, this study aimed to assess the use of Mineralocorticoid Receptor Antagonist as part of Guideline Directed Medical Therapy and determine the factors that influence its use among patients with heart failure with reduced ejection fraction who were followed at Wallaga University Comprehensive Specialized Hospital. A facility based retrospective cross-sectional study was conducted among patients with heart failure with reduced ejection fraction on follow up at Wallaga University Comprehensive Specialized Hospital, Nekemte, Ethiopia. The tool was developed by reviewing result parts of previously published articles and patient’s specific data were collected using a structured questionnaire. Descriptive statistics such as frequency, percentage, mean, and standard deviation were computed. Statically package for social sciences Version 26.0 was used for analysis and multivariable logistic regression was used to identify associations, with statistical significance set at p < 0.05. A total of 206 heart failure patients for whom Ejection Fraction was already done with reduced ejection fraction at Wallaga University Comprehensive Specialized Hospitals were included in this study. The mean (SD) age was 56.14 ± 13.72 and over 50% (55.8%) were female patients. About 15.5% of study patients had utilized Mineralocorticoid receptor antagonists during their follow up. The independent predictors of utilization of Guideline Directed Medical Therapy of Mineralocorticoid receptor antagonists among heart failure patients with reduced ejection fraction were duration since treatment greater than 24 months [AOR = 4.48, 95%CI= (1.84–10.90)] and Ejection fraction;30%-40%; [AOR = 3.18, 95%CI= (1.35–7.52)]. The utilization of guideline-directed target doses of mineralocorticoid receptor antagonists among patients with heart failure with reduced ejection fraction was low, with only 15.5% of patients achieving the recommended target dose. A treatment duration of more than 24 months and an ejection fraction of 30%–40% were independent predictors of guideline-directed mineralocorticoid receptor antagonist utilization. These findings highlight the need for interventions to optimize medication titration and improve adherence to heart failure treatment guidelines. Not applicable.