Guideline-Directed Medical Therapy in the Management of Cardiovascular Disease: A Cross-sectional Questionnaire-based Study amongst Indian Healthcare Professionals

Introduction: Guideline-Directed Medical Therapies (GDMT) are evidence-based treatments recommended by clinical practice guidelines for the management of Cardiovascular Diseases (CVDs). While GDMT is foundational for treating Heart Failure (HF), its adoption promotes uniform, evidence-driven practices across various cardiovascular conditions. This therapy includes drug classes such as Beta-Blockers (BB), AngiotensinConverting Enzyme inhibitors, Angiotensin-Receptor Blockers, and Angiotensin Receptor-Neprilysin Inhibitors (ACEi/ARB/ ARNI), Mineralocorticoid Receptor Antagonists (MRAs), and Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2i). Implementing GDMT can enhance cardiac function, improve quality of life and reduce hospitalisation and mortality risks. Aim: To understand the preferences of drug choice among Indian Healthcare Practitioners (HCPs) regarding the adaptation of GDMT in CVD management. Materials and Methods: A cross-sectional, questionnairebased study was conducted in India from December 2022 to March 2023. Participants (n=93) included cardiologists, electrophysiologists and cardiophysicians, who were actively involved in managing CVD. A predefined questionnaire consisting of seven questions, developed from existing literature, guidelines and expert opinions, was used. Responses were digitally analysed, with descriptive statistics presented as numbers and percentages. Results: For hypertension management in Acute Coronary Syndrome (ACS), telmisartan (60.22%) was the most preferred ARB, followed by metoprolol (48.39%; BB), amlodipine (39.78%; Calcium Channel Blockers [CCB]), and torsemide (32.26%; diuretics). For patients with diabetes and ACS, SGLT2i (89.29%) were favoured. Clopidogrel (56.99%) was the preferred oral antiplatelet drug alongside aspirin in ACS. In Acute Decompensated HF (ADHF), the preferred sequential addition of GDMT includes loop diuretics (44.74%) as the first choice, followed by ARB, SGLT2i, and MRAs as subsequent choices. One in four HF patients was on ARNI (37.36%) and SGLT2i (35.62%), while three in four HF patients were on BB (36.99%) and ACEi/ARBs (34.28%). In HF patients on loop diuretics and MRAs, the preferred doses were torsemide 10 mg with spironolactone 25 mg (57.32%) and torsemide 10 mg with spironolactone 50 mg (37.80%). In addition to symptomatic treatment with loop diuretics in HF patients, 72.50% of HCPs preferred ARNI, and 35.0% preferred ARBs as combination therapy. Conclusion: ARBs and BBs were preferred for hypertension in ACS, while SGLT2i were favoured for diabetes. Clopidogrel was the most popular P2Y12 inhibitor in ACS. For HF, HCPs favoured sequential therapy, with loop diuretics and ACEi/ARBs as the first and second choices and preferred combinations of ARNI or ARBs with loop diuretics for symptomatic HF.