CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 1, January – April 2024 12 AFRICA A strategy to improve adherence to guidelinedirected medical therapy (GDMT) and the role of the multidisciplinary team in a heart-failure programme Waleed AlHabeeb, Fakhr Alayoubi, Ahmed Hayajneh, Anhar Ullah, Fayez Elshaer Abstract Background: Heart failure (HF) patients place a heavy burden on the healthcare system because of their frequent need for in-patient treatment, emergency room visits and subsequent hospital stays. To provide proper care and effective therapy, practitioners have streamlined delivery techniques such as clinical pathways, checklists and pocket manuals. However, a description of the establishment of a disease-management programme, including a multidisciplinary team of physicians, clinical pharmacists and nurse specialists is required. The aim of this study was to highlight the role of the multidisciplinary team in a heart-failure programme by assessing the improvement in adherence to guideline-directed medical therapy. Methods: A retrospective, observational research was undertaken on patients with HF at a cardiac centre in Riyadh, to observe the HF patients’ management before (January to December 2014) and after (January to December 2015) the establishment of a programme. Results: The use of angiotensin converting enzyme inhibitors and angiotensin receptor blockers was 75.59% in 2014 at discharge and 81.17% in 2015 (p = 0.249). Beta-blockers use at release increased from 87.83% in 2014 to 94.53% in 2015 (p = 0.021). The flu vaccine was given to 48.24% of patients in 2014 and 75.13% of the patients in 2015 (p < 0.001). The pneumococcal vaccine was administered to 44.22% of patients in 2014 and 75.13% of patients in 2015 (p < 0.001). The ejection fraction improved from 30.21% in the first month to 39.56% in the 12th month (p = 0.001) in patients managed in 2015. Conclusion: The multidisciplinary heart-failure programme resulted in a positive effect, in the form of improved patient care after including the clinical pharmacist and nurse specialist. Keywords: angiotensin converting enzyme inhibitors, directed medical therapy, heart failure, immunisation, medical therapy Submitted 30/8/21; accepted 1/12/22 Published online 5/5/23 Cardiovasc J Afr 2024; 35: 12–15 www.cvja.co.za DOI: 10.5830/CVJA-2022-067 Heart failure (HF) is associated with reduced quality of life, increased morbidity and mortality rates and increased healthcare costs,1 therefore, it is a public health burden. Globally, it is estimated that approximately 26 million people are living with heart failure,2 with 5.7 million cases in the USA alone.3 The increase in prevalence of HF and the risk of acute exacerbation has resulted in a concomitant rise in the number of related hospitalisations.4 There was a one to 2% prevalence of HF in 2011, with its incidence approaching five to 10 per 1 000 persons per year in the Western world.2 There is a lack of studies assessing the incidence and prevalence of HF in the Middle East (ME). However, scattered data are available from a single centre in the ME region.5 There is an increased rate of out-patient visits, hospitalisations and re-admissions among HF patients than in previous years, representing a considerable burden to the healthcare system.6 Morbidity, premature mortality, unpaid care costs and loss of productivity correspond with HF as it imposes both direct costs to healthcare systems and indirect costs to society.7 The overall economic cost of HF was approximately $108 billion per annum worldwide in 2012.8 HF care generally involves patients with multiple co-morbidities in different settings and providers, which predisposes them to medication errors and complications that require special attention and utmost care.9 The nature of HF therapy needs patient self-management and constant monitoring, making the implementation of guidelinebased therapies a problem in clinical practice. To guarantee proper care and effective therapy, practitioners have streamlined delivery techniques such as clinical pathways, checklists and pocket manuals.10 However, there is a need to describe the development of a disease-management programme. Effective programmes require multidisciplinary involvement, including input from a cardiologist, HF specialist nurse and physiotherapist/exercise physiologist, as well as facilities for supervised exercise.11 They all play their respective roles in translating the guidelines into practical tools for adhering to and utilising such therapies. Angiotensin converting enzyme inhibitors (ACEIs),12 angiotensin receptor blockers (ARBs),13 beta-blockers (BB),14 mineralocorticoid receptor antagonists (MRA),15 and the newer angiotensin receptor neprilysin inhibitors (ARNI)16 have all revolutionised the field of HF through their ability to reduce mortality and hospitalisation rates. Patients with HF may also benefit from immunisation against influenza and pneumococcal pneumonia. Vaccination is an inexpensive strategy that has the potential to reduce the high rates of morbidity, death and total cost of care associated with HF.17 This study aimed to improve adherence to directed medical King Saud University, Riyadh, Saudi Arabia Waleed AlHabeeb, MD, walhabeeb@ksu.edu.sa Fakhr Alayoubi, MD Ahmed Hayajneh, MD Anhar Ullah, MD Fayez Elshaer, MD
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