Medicines for reduced ejection fraction heart failure in Central region of Portugal’s primary care: a 2022 observational study

Objective: To evaluate the accordance of prognostic medicines prescription (PMP), for persons with chronic heart failure with reduced ejection fraction (P-CHFrEF), attended in primary health care units in Central Portugal, with the European Society of Cardiology (ESC) 2021 August, guidelines. To know about mean age, median time since the diagnosis and last echocardiogram performance in P-CHFrEF. Methods: Observational, cross-sectional study of a random size representative sample, 95% confidence interval, and 8% error margin of the P-CHFrEF of a population on 31st December 2021. Age, gender, year of International Classification for Primary Care-2 (ICPC-2, K-77) problem classification input data, years since the last echocardiogram, ongoing PMP and the use of other chronic heart failure (CHF) drugs were gathered. Data were obtained from 11 Portugal Primary Health Care Units, invited by convenience, after an Ethics Committee approval. Results: From a universe of n=2,381 persons with CHF, n=453 (19.0%) P-CHFrEF was found. A size representative sample of P-CHFrEF of n=133 (5.6%), n=95 males (71.4%) was studied. Prescription of a renin-angiotensin system inhibitor (RAAS-I) was ongoing in 91.0%, beta-blocker (BB) in 75.2%, mineralocorticoid antagonists (MRA) in 40.6%, inhibitors of the sodium-glucose cotransporter-2 (SGLT2i) in 44.4%, neprilisine inhibitors 38.3% and loop diuretics in 72.2%. The optimized medical quadruple therapy was established in 28 patients (21.1%) and the triple one in 38 (28.6 %). Mean age was of 74.3±11.6 years, males 73.4±11.0 and females 76.6±12.9, p=0.088. The median time since the diagnosis was 6.0 for men and 4.0 for women, p=0.031. The median time since the last echocardiogram was 3.0, p=0.750 between genders. Conclusion: According to the 2021 ESC guidelines, prognostic modifying medicines were underused for 50.4% of P-CHFrEF. Even with these results, a reflection must be made, on the barriers physicians encounter, to comply with the ESC guidelines in such patients.