Background: The adoption of guideline recommendations of pharmacotherapy to improve
the clinical course of Heart Failure (HF) remains below par. Our objective is to evaluate the
impact of clinical audit on adherence to the Guideline-Directed Medical Therapy (GDMT) in patients
admitted with acute heart failure with reduced ejection fraction (EF).
Methods: A prospective interventional study was conducted over a period of 12 months from June
2018 to May 2019 in all patients admitted with acute heart failure with reduced ejection fraction.
The discharge prescriptions of patients who met the inclusion criteria were audited for appropriateness
in the usage of neurohormonal blockers and Ivabradine, by a clinical pharmacist on a monthly
basis. Audit results were presented to the practicing physicians every month and feedback was given.
Results: Discharge prescriptions of 716 patients who presented with HF were audited for the reasonable
or unreasonable omission of neurohormonal blocking drugs. The first-month audit revealed
that the unreasonable omission of Angiotensin-Converting Enzyme Inhibitors/ Angiotensin Receptor
Blockers/ Angiotensin Receptor Neprilisin Inhibitors ( ACEI/ARB/ARNI), Betablockers and
Mineralocorticoid Receptor Antagonists (MRA) were 24.5%, 13.1%, and 9.09% respectively,
which reduced to nil at the end of the study period (p=0.00). Initiation of Ivabradine before prescribing
or achieving the target dose of Betablocker was noted in 38.18% of patients in the first
month, which was also reduced to nil (p=0.00) at the end of the study.
Conclusion: This study reveals that periodic clinical audit improves adherence to GDMT in patients
admitted with heart failure with reduced ejection fraction.