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Physician adherence to ESC pharmacotherapy guidelines for Heart Failure in central hospital, Mahosot, Vientiane, Lao PDR

Thongxay CHANVISOUTH

Background: Heart failure places a significant burden on the patients and the health system worldwide. However, information about its burden in Low-income countries is scant. Witnessing a lack of adherence to heart failure guidelines amongst physicians in our environment prompted this study. The main objective is to determine physician adherence to ESC pharmacotherapy guidelines in heart failure in an economically resource-poor tertiary health facility.

Method: Review the prescription pattern of Neurohormonal blocker agent of 102 confirmed heart failure with reducing LVEF was carried out. Data from adherence evaluation were obtained from follow up information form outpatient clinic notes, while data on acute care medication and precipitating factors were from inpatient hospitalization notes.

Result: Heart failure (HFrEF) patients aged 59.03 ± 15.15 years, had NYHA III/IV symptoms (44.1%) and remain hypertension (21.5%), mean LVEF was 30.60± 7.14. hypertension and diabetes were predominant comorbidities, Etiology of heart failure was ICM (50%), Pharmacotherapy average three drug classes and consisted of ACEI/ARB (86.3%), Beta-blocker (50%), and MRA (32.24%) respectively. The use of Beta-blocker and MRA tents to be suboptimal. Combination pharmacotherapy: ACEI/ARB+BB (42.1%), ACEI/ARB+MRA (23.5%), BB+MRA (15.7%), three classes combination (18.7%). Target dose achievement ACEI (1.5%), beta-blockers, and MRA were not. the prescribing dosages were lower than the doses recommended by the guideline Most of the patients were prescribed starting doses in accordance with the guidelines: ACEI- 5mg/d (62.1%), BB-6,25mg/d (72.5%), MRA-25mg/d (97%). However, the maximum dose in this study was low: ACEI (40 mg/d), Beta-blocker (25mg/d), MRA (25mg/d).

Conclusion: As in the other country of the world nonadherence to guideline substantial problem in Laos. Our data confirm the need for a dedicated heart failure treatment program to optimize heart failure outcomes in a low resource environment. Our physicians will benefit from a structured heart failure education and feedback program. Better strategies for heart failure surveillance and management in Laos are need.