Implementation of Guideline-Directed medical therapy and factors in heart failure with reduced ejection fraction

The implementation of guideline-directed medical therapy in HFrEF patients was suboptimal, with only 1.3% achieving target doses of all three available therapies. No patients received ARNI or SGLT2 inhibitors due to availability and cost barriers. Key clinical factors such as baseline heart rate, diabetes, and hospitalization history influenced medication optimization. GDMT optimization in HFrEF remains inadequate in Ethiopia. Policy interventions (e.g., formulary expansion) and structured titration protocols are urgently needed.