Physician-adherence to pharmacotherapy guidelines for chronic heart failure in a tertiary health facility in Lagos, Nigeria

Abstract

Background: The increasing need for adherence evaluation of CHF amongst senior physicians in our environment prompted this study. Objective: To determine physician-adherence to pharmacotherapy guidelines in CHF in an economically resource-poor tertiary health facility. Methods: Review of prescription pattern of anti-CHF drug-class of 100 confirmed systolic-CHF patients was carried out. Data for adherence-evaluation were obtained from follow-up information from out-patient clinic-notes, while data on acute care medications and precipitating factors were from in-patient hospitalization notes. Results: CHF patients aged 54.7 ± 14.5 years, had NYHA III/IV symptoms (47%) and hypertension (61%). Anti-CHF pharmacotherapy averaged three drug-types; and consisted of ACEI/ARB (83%), β blockers-BB (48%), aldosterone antagonists (41%), CG (82%), and diuretics (75%). Adherence was assessed as good or complete in 50%, partial/ incomplete in 33%; but non-adherent in 17% of the total. While overall physician-adherence was 59.6% on single drug-classes, survival- advantage combinations with ACEI/ARB+BB and ACEI/ARB+BB+AA were present in 40% and 16% respectively. Older patients (≥ 65 years) had significantly lower prescriptions of all three classes of survival advantage anti-HF drugs, as follows: ACEI/ARB (56% versus 95%); BB (37.5% versus 52%); and AA (31% versus 63%) [p < .05]. Conclusion: BB and AA were under-prescribed. Physician-adherence to evidence-based anti-HF drug classes was variable and influenced by patient’s age. It was also comparable with reports from other countries. Our physicians will benefit from a structured HF education and feed-back program.