THỰC TRẠNG SỬ DỤNG CÁC NHÓM THUỐC NỀN TẢNG TRONG ĐIỀU TRỊ SUY TIM MẠN TÍNH CÓ PHÂN SUẤT TỐNG MÁU GIẢM TẠI KHOA KHÁM BỆNH - BỆNH VIỆN BẠCH MAI

Abstract

Aims: This study aims to evaluate the status of medical treatment of chronic heart failure with reduced ejection fraction (HFrEF) patients with four foundational therapies according to the current clinical guidelines at Outpatient Clinic, Bach Mai Hospital. Results: The proportions of patients who received four, three, two, and one of foundational drugs were 55.3%, 34.0%, 9.1%, and 1.6%, respectively. The prescription rate of renin-angiotensin inhibitors (RASi), beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and SGLT2 inhibitors (SGLT2i) were 96.8%, 76.3%, 87.7%, and 82.6%, respectively. Treatment expense was the most common reason for the lack of treatment of SGLT2i and RASi (86.4% and 62.5%, respectively), while adverse effects and contraindications were the leading cause of MRA and BB’s lack of prescription. 100% and 68% of patients received SGLT2i, and MRA achieved the optimal dose. Only 3.7% and 3.1% of patients reached the optimal doses of RASi and BB, respectively. The leading cause of suboptimal dose treatment was intolerance with higher doses (symptomatic hypotension, progressive kidney failure, and hyperkalemia). Conclusion: Most patients received three to four foundation heart failure therapies; however, many patients did not reach optimal doses. Adverse effects, contraindications, and high costs of treatment were the main barriers to implementing guideline-directed therapy.