UTILIZATION, OPTIMIZATION AND PATIENT ADHERENCE OF BETA BLOCKERS IN HEART FAILURE WITH REDUCED EJECTION FRACTION PATIENTS HAVING FOLLOW UP AT PUBLIC HOSPITALS IN HARAR, EASTERN ETHIOPIA: HOSPITAL BASED CROSS SECTIONAL STUDY

Abstract

Optimal use of guideline-directed medical therapy is an important strategy in preventing cardiovascular morbidity and mortality from heart failure. The use of guideline recommended beta blockers is an important pillar of guideline directed medical therapy. Adherance to medication is also big challenge in under developed countries. Utilization and optimization of Beta blockers and patient’s adherence are understudied in eastern Ethiopia. Objective: The study aimed to assess utilization, optimization and patient adherence of Beta blocker therapies in Heart failure with reduced ejection fraction patients having follow up at two public hospitals in Harar, Eastern Ethiopia. Method: A hospital-based cross-sectional study was conducted at two public hospitals on the utilization, optimization and patient adherence of Beta blockers in the management of Heart failure with reduced ejection fraction patients from December 2023 to January 2024 G.C. A total of 174 Heart failure with reduced ejection fraction Patients who had follow up for at least three months were recruited during their routine clinic visit and consent was obtained from all participants. A medication Adherence Report Scale questioner was used for addherance data collection. Data were collected through patient interview and reviewing the patient’s medical records.The Collected Data was analysed using IBM SPSS version 29.0. Results: The study found beta blocker utilization in 150 (86.2%) patients. Among the patients taking beta blockers only 83(47.7%) participants were on guideline-recommended beta blockers. The other 38.5% of patients taking Beta blockers were on Metoprolol tartrate (32.2%),Atenolol (5.2%) and propranolol in 2 patients,which are not guideline-recommended.These findings signify underutilization of guideline-recommended beta blockers. Age above 60 years,duration of treatment follow-up for more than 1 year and absence of peripheral edema were positively associated with beta blocker utilization. Conclusion: Even though guideline-recommended beta blocker at optimal doses exerts a clinical benefit, this study points out guideline recommended beta blockerss are underutilized and more importantly used at suboptimal doses among the study participants. The self-reported medication nonadherence among Heart failure patients was considerably high. To achieve the desired clinical benefit, physicians should attempt to provide guideline-recommended beta blockers at the maximum tolerable dose.