CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 1, January – April 2024 14 AFRICA to 4.25% (p < 0.001). A similar study by Rich et al.3 demonstrated that a randomised, multidisciplinary intervention reduced re-admission rates for HF by 56% and saved almost $500 for each enrolled person. The study provided strong validation for the concept of a multidisciplinary approach. The present study reported significant clinical improvement in EF (p = 0.001) and reduction in re-hospitalisation (p < 0.0011) between the first and 12th month in 2015 after commencement of the GDMT. Similar to our study, in a study by Joseph et al., a statistically significant difference across the study groups was seen after the use of GDMT, which might be attributable to more targeted care offered by the HF clinic. HF clinics, which are extensively used in other countries, have been proven to minimise rates of re-hospitalisation and death, as well as to enhance patient outcomes by strict adherence to GDMT.18 The major contributor to the underutilisation of evidencebased HF therapies includes medication adherence. In some studies, there was a significant contribution of medication non-adherence to hospital admission in 7.9% of subjects, which was revealed during the analysis of HF hospitalisations in the light of conforming with the guidelines–HF registry.19,20 The literature reports pneumonia as the leading cause of death in HF patients and it should be considered as a significant mortality indicator. In another study, one of the significant findings was the administration of pneumococcal vaccine, which was found to be increased by 31%.21 MRA and ARNI were not used to track patient progress in our HF patients. The investigators added new medications to the treatment regimen based on the outcomes of the present trial, and the findings of the analytical process will be released shortly. With the exception of ACEI, the present study found a considerable effect of a multidisciplinary approach employing a guideline-translated toolkit, leading to a significant improvement in usage and compliance with recommendations. However, there was a tendency towards improvement in patients as well. To the best of our knowledge, this research is the first to be reported in this context from our region. There were a few limitations of the study. The study design was cross-sectional and in future, prospective studies should be conducted. Also the study period of one year might not be justifiable to describe a causal relationship. Conclusion Implementing a multidisciplinary HF programme improved the use of GMDT in HF patients and increased immunisation awareness and adherence to prescriptions. The interdisciplinary approach in the HF programme is crucial in implementing the guidelines and delivering the appropriate education to the team Table 1. Baseline characteristics Variables Total 2014 2015 p-value Socio-demographic characteristics Age, years, mean ± SD 58.94 ± 15.33 59.82 ± 14.63 58.02 ± 16.00 0.282 Gender, n (%) Male 257 (76.26) 135 (78.95) 122 (73.49%) 0.239 Female 80 (23.74) 36 (21.05) 44 (26.51%) BMI, mean ± SD 28.99 ± 8.94 29.79 ± 9.71 28.17 ± 8.01 0.095 Nationality, n (%) Saudi 242 (71.81) 129 (75.44) 113 (68.07) 0.133 Non-Saudi 95 (28.19) 42 (24.56) 53 (31.93) Past co-morbidities, n (%) Obesity 102 (30.27) 53 (30.99) 49 (29.52) 0.768 Diabetes mellitus 195 (57.86) 101 (59.06) 94 (56.63) 0.650 Hypertension 220 (67.2) 123 (75.19) 97 (58.43) 0.001* Atrial fibrillation 47 (13.95) 21 (12.28) 26 (15.66) 0.370 Stroke 19 (5.64) 13 (7.60) 6 (3.61) 0.113 Hypothyroidism 22 (6.53) 8 (4.68) 14 (8.43) 0.163 Anaemia 165 (48.96) 88 (51.46) 77 (46.39) 0.384 COPD 20 (5.93) 14 (8.19) 6 (3.61) 0.076 CAD 185 (54.90) 105 (61.40) 80 (48.19) 0.015* Dyslipidaemia 190 (56.38) 110 (64.33) 80 (48.19) 0.003* NYHA class I 53 (15.73) 25 (14.62) 28 (16.87) 0.571 NYHA class II 198 (58.75) 93 (54.39) 105 (63.25) 0.098 NYHA class III 86 (25.60) 53 (30.99) 33 (20.00) 0.021* NYHA class IV 0 0 0 – Haemoglobin (g/dl) 12.32 ± 2.25 12.01 ± 2.26 12.65 ± 2.20 0.009* Creatinine (μmol/l) 138.9 ± 78.74 151.1 ± 93.16 126.4 ± 58.08 0.004* Pro-BNP (pg/ml) 7189 ± 9839 7651 ± 7910 6747 ± 11393 0.410 BMI, body mass index; COPD, chronic obstructive pulmonary disease; CAD, coronary artery disease; BNP, brain natriuretic peptide; NYHA, New York Heart Association; SD, standard deviation. *p < 0.05 significant. Table 3. Thirty-day re-admission rate Indicators in 2015 Indicators in 2014 Difference (95% CI) p-value 30-day re-admission rate (%) 4.25 14.21 –9.96 (–15.53, –4.36) < 0.001* *p < 0.05 significant. Table 2. Comparison of medication use before and after the programme Indicators 2015 2014 p-value ACEI/ARB (%) 81.17 75.59 0.249 BB (%) 94.53 87.83 0.021* Flu vaccine (%) 75.13 48.24 < 0.001* Pneumococcal vaccine (%) 75.13 44.22 < 0.001* ACEI/ARB, angiotensin converting enzyme inhibitors/angiotensin receptor blockers; BB, beta-blockers. *p < 0.05 significant. ACEI-ARB β-blockers Flu vaccine Pneumococcal Year 2014 Year 2014 83.74% 85.38% 42.50% 38.75% Year 2015 91.18% 93.37% 72.22% 83.85% Year 2015 Frequency (%) 120 100 80 60 40 20 0 Fig. 1. Frequency (%) of patients discharged on ACEI/ARB and BB, and with immunisation.
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