Experiences of a University Hospital on Adhering to ESC Guidelines in Patients with Chronic Ischaemic Heart Failure
Keywords: Guidelines, heart failure, medication adherence
Introduction: Ischaemic heart failure (HF) is a common public health problem that is associated with increased mortality, morbidity and medical costs. This study aimed to investigate the percentage of patients with HF who are taking target doses of the drugs to improve the mortality rate and assess the reasons for the patients' non-adherence to treatment guidelines during the follow-up period. Patients and Methods: Between January 2017 and December 2018, 480 patients who had been diagnosed with ST elevation myocardial infarction (STEMI) and had undergone primary percutaneous coronary intervention with a left ventricular ejection fraction (LVEF) of < 40% were enrolled in this study at our centre. The percentage of patients taking target doses of drugs that improved the mortality rate according to the 2016 European Society of Cardiology Guidelines for the treatment of HF, such as beta blockers (BB), angiotensin converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB) and mineralocorticoid receptor antagonists (MRA) at the time of discharge and at the 6-month follow-up period was investigated. Results: Of the 480 patients, the follow-up data of 430 patients were available and the percentages of patients prescribed with ACEI/ARB, BB and MRA at discharge were 86%, 89% and 28%, respectively. At the 6-month follow-up, the percentages of patients using ACEI/ARB, BB and MRA were 72%, 78% and 42%. About 7% of patients using BB switched to a different BB and 5% of the patients using ACEI were found to switch to an ARB. The percentages of patients taking target doses of ACEI/ARB, BB and MRA were 28%, 22% and 24%, respectively. Metoprolol succinate, ramipril and spironolactone were the most prescribed agents. Worsening of renal function, hyperkalaemia and bradycardia were the main reasons for non-achievement of target doses during the follow-up period. Conclusion: In clinical practice, the percentage of patients with ischaemic HF who were receiving optimal target doses of BB, ACEI and MRA was far below the desired levels as compared to the European Society of Cardiology (ESC) guidelines.