Quality of Care of Patients with Stable and Stabilized Heart Failure with Reduced Ejection Fraction at the Medical Wards of a Tertiary Center in the Philippines: A Retrospective Cross-sectional Study
DOI:
https://doi.org/10.47895/Keywords:
Abstract
Background. Heart failure with reduced ejection fraction (HFrEF) remains a major contributor to morbidity and mortality among Filipinos. Contemporary ESC and ACC/AHA guidelines emphasize quality indicators aimed at optimizing outcomes.
Objective. The study aimed to evaluate the quality of care received by stable and stabilized HFrEF patients admitted to the medical wards of a tertiary center in the Philippines, focusing on physician adherence to guideline-recommended quality indicators.
Methods. A cross-sectional study was done through review of charts involving all adult HFrEF patients aged ≥19 years admitted to the medical wards of a tertiary hospital from November 2022 to April 2023. Quality-of-care assessment included prescription of Class I guideline-directed medical therapy (GDMT) at discharge for eligible patients, as well as non-pharmacologic indicators such as scheduling of post-discharge follow-up and referrals to a heart failure clinic or cardiac rehabilitation. Descriptive statistics were used; analyses were performed using STATA 13.1. QI of 80% was considered to be optimal quality of care.
Results. A total of 148 patients were included; most were male (69.6%) with a mean age of 56 ± 14 years. Hypertension (62.8%) and diabetes (41.2%) were the most frequent comorbidities. Beta-blockers, ACEi / ARB / ARNI, and diuretic prescription were high (95.17%, 91.41%, and 100%, respectively). In contrast, prescription of MRA and SGLT2i was 68.50% and 55.56%, respectively. Post-discharge physician appointments within 4 weeks were arranged in 91.54%. Only 27.7% were referred to cardiac rehabilitation, and 2.31% were referred to the heart failure clinic.
Conclusion. Quality of heart failure care at the medical wards upon discharge is acceptable for pharmacologic quality indicators and post-discharge appointments. However, referrals to specialized heart failure services and cardiac rehabilitation remain suboptimal and represent opportunities for quality improvement.