Quality of Care among Post–discharge Patients with Heart Failure with Reduced Ejection Fraction (HFrEF) at the Outpatient Department (OPD) of a Tertiary Center

Authors

  • Kevin Paul DA. Enriquez, MD Division of Cardiovascular Medicine, Department of Medicine, Philippine General Hospital, University of the Philippines Manila https://orcid.org/0000-0003-1127-902X
  • Sherry Mae C. Mondido, MD Division of Cardiovascular Medicine, Department of Medicine, Philippine General Hospital, University of the Philippines Manila
  • Mark John D. Sabando, MD Division of Cardiovascular Medicine, Department of Medicine, Philippine General Hospital, University of the Philippines Manila
  • Tam Adrian P. Aya-ay, MD Division of Cardiovascular Medicine, Department of Medicine, Philippine General Hospital, University of the Philippines Manila
  • Ronald Allan B. Roderos, MD Division of Cardiovascular Medicine, Department of Medicine, Philippine General Hospital, University of the Philippines Manila
  • Nigel Jeronimo C. Santos, MD Division of Cardiovascular Medicine, Department of Medicine, Philippine General Hospital, University of the Philippines Manila
  • Bryan Paul G. Ramirez, MD Division of Cardiovascular Medicine, Department of Medicine, Philippine General Hospital, University of the Philippines Manila
  • Frances Dominique V. Ho, MD College of Medicine, University of the Philippines Manila
  • Lauren Kay M. Evangelista, MD Division of Cardiovascular Medicine, Department of Medicine, Philippine General Hospital, University of the Philippines Manila
  • Felix Eduardo R. Punzalan, MD Division of Cardiovascular Medicine, Department of Medicine, Philippine General Hospital, University of the Philippines Manila

DOI:

https://doi.org/10.47895/amp.vi0.11251

Keywords:

outpatient, HFrEF, physician adherence, management

Abstract

Background and Objective. Physician adherence to the recommended management of patients with heart failure with reduced ejection fraction (HFrEF) at the outpatient setting is crucial to reduce the burden of subsequent rehospitalization, morbidity, and mortality. Recently updated guidelines recommend early and rapid titration to optimal doses of medications in the first 2 to 6 weeks of discharge. In the absence of local data, our study evaluates physician adherence to guideline-recommended treatment in this setting.

Methods. This is a retrospective cross-sectional study among post-discharge HFrEF patients at the outpatient department from December 2022 to May 2023 with a follow-up within three months. Clinical profile and treatment were extracted from medical records. Adherence to the 2021 ESC Guidelines Class I recommendations, among eligible patients, is measured as quality indicators. Data are presented using descriptive statistics.

Results. A total of 99 patients were included in the study. Overall, adherence to prescription of beta-blockers (94.8%), ACEI/ARNI/ARBs (88.5%), and diuretics (100%) were high. Prescription of mineralocorticoid receptor antagonists (MRA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i) were 67% and 57.3%, respectively. Over three months of follow-up, improvement in the quality of care was demonstrated with ACEI/ARNI/ARBs (81.8% to 90.9%), MRA (68.7 to 81.2%), and SGLT2i (58% to 67.7%). Beta-blocker use is consistently high at 97%. In the 3rd month post-discharge, titration to optimal doses was achieved in only 26.4%, 15%, and 6.25% for those on beta-blockers, ACEI/ARNI/ARB, and MRA, respectively. For non-pharmacologic management, referral to HF specialty was made in 30% and cardiac rehabilitation in 22.2%.

Conclusion. Among patients with HFrEF seen at the outpatient, there is good physician adherence to betablockers, ACEI/ARNI/ARBs, and diuretics. MRA and SGLT2i prescription, referral to HF specialty and cardiac rehabilitation, and up-titration to optimal doses of oral medications for HF need improvement. Hospital pathway development and regular performance evaluation will improve initiation, maintenance, and up-titration of appropriate treatment.

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Published

2024-10-21

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Articles

How to Cite

1.
Quality of Care among Post–discharge Patients with Heart Failure with Reduced Ejection Fraction (HFrEF) at the Outpatient Department (OPD) of a Tertiary Center. Acta Med Philipp [Internet]. 2024 Oct. 21 [cited 2025 Apr. 4];. Available from: https://actamedicaphilippina.upm.edu.ph/index.php/acta/article/view/11251

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