Drug utilization and dose optimization following guideline-directed medical therapy in HFrEF patients, real-world evidence from a private hospital in Indonesia

Background: Guideline-directed medical therapy (GDMT) was associated with reduced risk of mortality and morbidity among patients with heart failure with reduced ejection fraction (HFrEF). Evidence from North America, Europe, and Asia suggests that compliance with GDMT remains low despite the availability and dissemination of clinical practice guidelines.
Objectives: This study aims to describe drug utilization and dose optimization in accordance with GDMT in patients with HFrEF.
Methods: A retrospective cohort study with a 1-year follow-up was conducted in a private hospital in Indonesia. Patient's-level data was taken from medical records of HFrEF patients between January 2018 to December 2019. This study included patients with left ventricular ejection fraction (LVEF) ≤ 40%. GDMT was defined as triple therapy which consists of beta-blockers (BB), renin-angiotensin aldosterone system inhibitors (RAASI) (angiotensin converting enzyme inhibitors [ACEI], or angiotensin receptor blockers [ARB], or angiotensin receptor-neprilysin inhibitors [ARNI]), and mineralocorticoid receptor antagonists (MRA). The patient's medications were examined at baseline and at 1-year follow-up.
Results: 127 HFrEF patients were included. At baseline, 90 (70.86%) patients receive ACEI, 17 (13.38%) patients receive ARNI, and 20 (15.76%) patients receive ARB. BB was prescribed to 107 (84.25%) patients whereas MRA was prescribed to 74 (58.27%) patients. GDMT with triple therapy was used in 68 (53.54%) patients. At one year follow-up, the proportion of patients with medication initiation
or dose increase were 3.15% for MRA, 3.15% for BB, 15.75% for ACEI, 3.94% for ARB, and 3.15% for ARNI. There was no discontinuation of medicine or dose decrease found. The number of patients who achieved the target dose after 1 year were 3 for MRA, 10 for BB, 68 for ACEI, 12 for ARB, and 9 for ARNI.
Conclusion: Almost half of the HFrEF patients in the hospital did not receive therapy according to GDMT and only a few patients had their doses increased within a year.