Evaluation of Goal-Directed Medical Therapy and Follow-Up Practice in Patients With Chronic Heart Failure: A Single-Centre Experience

Abstract

Guideline-directed medical therapy (GDMT) and device therapy are proven to reduce mortality and morbidity for patients with heart failure (HF). This study aimed to evaluate prescribing practice of GDMT and follow-up for patients who reside in the Te Whatu Ora – Waikato region. Heart failure up-titration clinics are run by six HF nurses and details of patients are entered into an Excel database. Four registrars and two house officers extracted clinical details and outcomes from Clinical Workstation (CWS), Te Whatu Ora’s enterprise health system and NZEPS (NZ electronic prescribing system). Data were then analysed with JASP. A total of 642 patients were referred between 1 November 2021 to 31 July 2022. Of 642 referred patients, 69 were non-engaging with the service. A total of 495 (77.1%), 78 (12.2%), and 69 (10.7%) patients had heart failure with reduced ejection fraction, heart failure with mid-range ejection fraction, and heart failure with preserved ejection fraction, respectively. Prescription of beta blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, Entresto, spironolactone, and empagliflozin accounted for 89%, 31%, 58%, 46%, and 7%, respectively. Sixty-five (10%) patients had a left bundle branch morphology. Thirty-six (5.6%) patients had a cardiac resynchronisation therapy device implanted and six (0.9%) had an implantable cardioverter defibrillator implanted. Of the 642 patients, 187 (29%) had post-GDMT echocardiogram performed, of which 76 patients (40.6%) had improvement in their ejection fraction post-GDMT. Spironolactone and device therapy were underutilised in this cohort. A total of 71% of patients had no post-GDMT echocardiogram and 60% of patients who had their echocardiogram done after titration had no improvement in their EF. Further research must be conducted to evaluate reasons for prescribing practice, and follow-up practices to ensure that patients receive adequate follow-up.