AFRICA CARDIOVASCULAR JOURNAL OF AFRICA • Kenya Cardiac Society July 2023 24 On physical examination, he was noted with left sided UMN facial nerve palsy and left sided dense hemiplegia of the UL and hemiparesis of the LL (grade 3 for the extensors and grade 4- for the flexors). With right lower limb ataxia, loss of tactile sensation on the left side and left temporal hemianopia. BP 105/62mmHg, HR 72bpm. A CT head and Angiography: Summary of CT Head and Angiography Right MCA acute infarct (hyper dense proximal M1 segment of the right MCA with a tight stenosis) in keeping with an acute thrombus. An assessment of an acute cerebral infarct was made. He was thrombolysed and scheduled for thrombectomy. Thrombectomy report PT graphix guide wire 0.014 IN *182 cmpassed through the thrombus. A Solitaire X 6mm*30mm stent was used to successfully retrieved the clot. Troponin came back at 7, 000 (17, 968 from admission) Due to persistently elevated BPs, he was then referred to the Cardiology clinic, where the following vital signs were recorded. To determine his blood pressure and adequately tailor his antihypertensive medication, it was determined that he underwent further testing. Full CT aortogram Findings: Dilatation of the left subclavian artery at its origin from the aortic arch. Circumferential wall thickening of the left subclavian at the same level measuring up to 7 mm, extending 3.2 cm distally. Left renal artery stenosis with near complete occlusion consistent with Takayasu arteritis Type IIb. Cardiac catheterization Conclusion Takayasu arteritis is a rare systemic vasculitis that primarily affects the aorta and its major branches. Diagnosing Takayasu arteritis continues to be a challenge. The patient presented had a diagnosis of Takayasu arteritis, and suffered coronary artery disease followed by an ischemic stroke. Findings: Conclusion: Mid LAD CTO, central aortic pressure of 152/96mmHg. Submission ID: 36 PHYSICIANS’ ADHERENCE TO GUIDELINES ON PRESCRIPTION AND UPTITRATION OF MEDICAL THERAPY FOR HEART FAILURE WITH REDUCED EJECTION FRACTION WILLY MUCYO Background High prescription rate and uptitration to target dose of guidelinedirected medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF), for eligible patients, is associated with reduced mortality and hospitalization due to heart failure. The aim of the study is to determine the physicians’ adherence rate to current GDMT prescription and uptitration guidelines at a tertiary care university hospital in Nairobi, Kenya. Methods We reviewed medical files of all HFrEF patients admitted from January 2020 to December 2022. We calculated the Guideline Adherence Index (GAI) and the QUality of Adherence to guideline recommendations for LIFe-saving treatment in heart failure (QUALIFY) scores. From worst to best, GAI scores range from 0 to 100%, while QUALIFY scores range from 0 to 1. GAI is the proportion of patients for whom GDMT was prescribed among eligible patients, while the QUALIFY score is calculated using an algorithm that takes into account the appropriateness of the prescription and the uptitration to target dose. Table 1. Physicians’ adherence scores for GDMT prescription and uptitration guidelines. Table 1: GAI and QUALIFY scores at discharge and at 6 months follow-up. GAI: Guideline Adherence Index; QUALIFY: QUality of Adherence to guideline recommendations for LIFesaving treatment in heart failure; ACEI: angiotensin receptor blocker; ARNI: angiotensin neprilysin inhibitor, MRA: mineralocorticoid receptor inhibitor; SGLT2i: Sodium-Glucose Transport Protein 2 (SGLT2) Inhibitor, SD: standard deviation. Results Medical files of 280 patients with HFrEF were reviewed. The mean age was 62.8 (±14.2); 58.9% were men; 40.6% had new onset HFrEF; and 35% had ischemic heart disease. MRA and SGLT2i had the lowest adherence scores. GAI scores were ACEI/ARNI/ ARB: 66.2%, beta blocker: 71.7%, MRA: 42.6%, at discharge, and 86.3%, 84.4%, 61.2%at 6 months follow-up. Mean QUALIFY scores were 0.48 (±0.42), 0.57 (±0.39), and 0.34 (±0.31), respectively. GAI score SGLT2i was 38.9% at 6 months. Adherence scores varied
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