Evidence map›Paper›PMID 41068678›Full record

ArticleBMC cardiovascular disorders2025

Implementation of Guideline-Directed medical therapy and factors in heart failure with reduced ejection fraction.

Firaol Wassie Bekele, Wubshet Abraham Alemu, Koricho Simie Tolla, Abdulkadir Urgessa Jada, Mengesha Akale Tekle, Muhammedawel Kaso Adem, Hassen Ahmed Yesuf

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Article in BMC cardiovascular disorders, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

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0cells of the map it votes in
3citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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3 · Its place in the literature

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3 citing papers in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

7 authors.

Firaol Wassie BekeleDepartment of Internal Medicine, College of Health Sciences, Arsi University, Asella, Ethiopia.
Wubshet Abraham AlemuDepartment of Internal Medicine, College of Health Sciences, Arsi University, Asella, Ethiopia. wubea.2009@gmail.com.
Koricho Simie TollaDepartment of Internal Medicine, College of Health Sciences, Arsi University, Asella, Ethiopia.
Abdulkadir Urgessa JadaDepartment of Internal Medicine, College of Health Sciences, Arsi University, Asella, Ethiopia.
Mengesha Akale TekleDepartment of Internal Medicine, College of Health Sciences, Arsi University, Asella, Ethiopia.
Muhammedawel Kaso AdemDepartment of Public Health, College of Health Sciences, Arsi University, Asella, Ethiopia.
Hassen Ahmed YesufDepartment of Biomedical Science, School of Medicine, College of Medicine and Health Sciences, Woldia University, Woldia, Ethiopia.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundTo evaluate the implementation of guideline-directed medical therapy and identify associated clinical factors among patients with heart failure with reduced ejection fraction (HFrEF) receiving follow-up at Asella Referral and Teaching Hospital, Ethiopia.

methodsWe conducted a hospital-based cross-sectional study involving 156 patients with HFrEF attending follow-up at Asella Referral and Teaching Hospital from October to December 2023. Eligible participants were adults with LVEF ≤ 40%, ≥ 6 monthly clinic visits, and a recent echocardiogram within two years. Data were collected through structured interviews and chart review and analyzed using SPSS version 26.

resultsPrescription rates for renin-angiotensin system inhibitors (RASI), beta-blockers, and mineralocorticoid receptor antagonists (MRA) were 98.1%, 96.8%, and 70.5%, respectively. However, only 30.8% achieved target doses of RASI, 1.3% for beta-blockers, and 67.3% for MRA. Only 1.3% were on all three therapies at guideline-recommended target doses. No patient received angiotensin receptor-neprilysin inhibitors (ARNI) or sodium-glucose co-transporter 2 inhibitors (SGLT2i), primarily due to cost and availability. In multivariable analysis, baseline bradycardia (adjusted odds ratio [AOR] 13.7; 95% CI 1.8-100.3; p = 0.010) and diabetes mellitus (AOR 4.5; 95% CI 1.13-17.9; p = 0.033) were significantly associated with achieving RASI target doses. Absence of prior heart failure hospitalization was associated with a lower likelihood of achieving the MRA target dose (AOR 0.4; 95% CI 0.18-0.9; p = 0.029).

conclusionThe implementation of guideline-directed medical therapy in HFrEF patients was suboptimal, with only 1.3% achieving target doses of all three available therapies. No patients received ARNI or SGLT2 inhibitors due to availability and cost barriers. Key clinical factors such as baseline heart rate, diabetes, and hospitalization history influenced medication optimization. GDMT optimization in HFrEF remains inadequate in Ethiopia. Policy interventions (e.g., formulary expansion) and structured titration protocols are urgently needed.

Indexed as

Adrenergic beta-AntagonistsAngiotensin-Converting Enzyme InhibitorsCardiovascular AgentsGuideline AdherenceHeart FailureMineralocorticoid Receptor AntagonistsPractice Guidelines as TopicPractice Patterns, Physicians'Stroke VolumeVentricular Function, LeftAgedCross-Sectional StudiesEthiopiaFemaleHumansMaleAdrenergic beta-AntagonistsAngiotensin-Converting Enzyme InhibitorsCardiovascular AgentsMineralocorticoid Receptor AntagonistsARNIEthiopiaGuideline-directed medical therapyHeart failure with reduced ejection fractionMedication adherenceSGLT2 inhibitors

Identifiers

PMID41068678
PMCPMC12512486

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.