Patterns of guideline directed medical therapy (GDMT) in congestive heart failure patients at RSUD. Raden Mattaher Jambi
DOI:
https://doi.org/10.22437/proca.v1i2.50457Keywords:
Congestive Heart Failure (CHF); Guideline-Directed Medical Therapy (GDMT); Drug Utilization Pattern; Beta-Blocker; Renin-Angiotensin-Aldosteron System (RAAS) Inhibitor; Mineralocorticoid Receptor Antagonists (MRA); Sodium-Glucose Cotransporter-2 Inhibitors (SGLT2i)Abstract
Background: Congestive heart failure (CHF) is a condition with a high mortality rate and a significant economic burden, requiring comprehensive and systematic therapeutic management. Guideline-Directed Medical Therapy (GDMT) recommends four pillars of therapy for patients with heart failure with reduced left ventricular ejection fraction: renin-angiotensin-aldosterone system (RAAS) inhibitors, beta-blockers, mineralocorticoid receptor antagonists (MRAs), and SGLT2 inhibitors, with diuretics used in certain conditions. Objective: This study aims to obtain a pattern of Guideline-Directed Medical Therapy (GDMT) in congestive heart failure patients at RSUD.Raden Matther Jamb Methods: This retrospective observational study describes the pattern of GDMT use in congestive heart failure patients at RSUD.Raden Matther Jambi during January–July 2025. Results: The results show that from 99 congestive heart failure patients, 70% received bisoprolol (beta-blocker), 34% received RAAS inhibitors (ACEi/ARB), and 4% received ARNI. MRAs were used by 27% of patients, and SGLT2 inhibitor use was not found. Conclusion: These findings indicate barriers to GDMT implementation related to healthcare financing policies, limited access to generic and innovator drugs, and patient adherence to therapeutic regimens.
Downloads
References
[1] PERKI 2023. Pedomam Tatalaksana Penyakit Gagal Jantung [Internet]. Perhimpunan Dokter Spesialis Kardiovaskular Indonesia. Jaka; 2023. 89 p. Available from: http://www.nber.org/papers/w16019
[2] Chen QF, Chen L, Katsouras CS, Liu C, Shi J, Liang D, et al. Global burden of heart failure and its underlying causes in 204 countries and territories, 1990-2021. Eur Hear journal Qual care Clin outcomes. 2025 Jun;11(4):493–509.
[3] Delima D, Mihardja L, Siswoyo H. Prevalensi dan Faktor Determinan Penyakit Jantung di Indonesia. Indones Bull Heal Res. 2009;37(3).
[4] Mumpuni H, Adhi Kusumastuti D, Purnasidha Bagaswoto H, Yuli Setianto B. Acta Cardiologia Indonesiana Epidemiology, Aetiology and Risk Profile of Heart Failure in a Tertiary Referral Hospital: a Report from the Sardjito Heart Failure Registry. ACI (Acta Cardiol Indones. 2020;7(1):7–12.
[5] Kemenkes RI. Laporan Riskesdas Provinsi Jambi 2018. Jakarta: Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan (LPB); 2019.
[6] Eguchi S, Morita Y, Mitani H, Kanegasaki A, Iwasaki K, Yoshikawa T, et al. Burden of Repeated Hospitalizations on Patients with Heart Failure: An Analysis of Administrative and Claims Data in Japan. Drugs - real world outcomes. 2022 Sep;9(3):377–89.
[7] Dewi IGAAGS, Putri LALN, Silalahi LD, Dewi IGAWP, Hapsari MD, Dewa JAP, et al. Systematic literature review on sterile injectable dates of use, stability and implications for use. Svāsthya Trends Gen Med Public Health. 2025 Jan. 12;2(1):e66. https://doi.org/10.70347/svsthya.v2i1.66
[8] Fedacko J, Tuppo EE, Singh RB, Elkilany GN, Hristova K. Chapter 2 - Epidemiology and mortality due to heart failure. In: Singh RB, Fedacko J, Hristova K, Elkilany GN, editors. Pathophysiology, Risk Factors, and Management of Chronic Heart Failure [Internet]. Academic Press; 2024. p. 23–40. Available from: https://www.sciencedirect.com/science/article/pii/B9780128229729000171
[9] AHA/ACC/HFSA. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. J Card Fail. 2022 May;28(5):e1–167.
[10] Wang X, Lei M, Wang J, Sun X, Li C, Li Y, et al. The Effectiveness of In-hospital Initiation Guideline-directed Medical Therapy on the Prognosis of Patients with Heart Failure after Acute Anterior Myocardial Infarction. 2024.
[11] Lei M, Wang J, Wang X, Sue X, Li C, Yang Y, et al. The effect of guideline-directed medicine on patients with new-onset heart failure following acute myocardial infarction. Front Cardiovasc Med. 2025;12:1639213.
[12] Subagyo A, Andrianto A, Wiyasihati S, Ratri A. Chronic Heart Failure Management: A Literature Review of Guideline-Directed Medical Therapy. Int J Sci Adv. 2024 Jan 1;5.
[13] Scholten M, Midlöv P, Halling A. Disparities in prevalence of heart failure between the genders in relation to age, multimorbidity and socioeconomic status in southern Sweden: a cross-sectional study. Scand J Prim Health Care. 2023 Jun;41(2):160–9.
[14] van Deursen VM, Urso R, Laroche C, Damman K, Dahlström U, Tavazzi L, et al. Co-morbidities in patients with heart failure: an analysis of the European Heart Failure Pilot Survey. Eur J Heart Fail. 2014 Jan;16(1):103–11.
[15] Mastromarino V, Casenghi M, Testa M, Gabriele E, Coluccia R, Rubattu S, et al. Polypharmacy in heart failure patients. Curr Heart Fail Rep. 2014 Jun;11(2):212–9.
[16] Alsultan MM, Alamer R, Alammar F, Alzlaiq W, Alahmari AK, Almalki ZS, et al. Prevalence of polypharmacy in heart failure patients: A retrospective cross-sectional study in a tertiary hospital in Saudi Arabia. Saudi Pharm J SPJ Off Publ Saudi Pharm Soc. 2023 Dec;31(12):101875.
[17] Haider R. Congestive Coronary Heart Failure. Cardiol Res Reports. 2023 Nov 30;5:1–12.
[18] Rosano GM, Vitale C, Seferovic P. Heart Failure in Patients with Diabetes Mellitus. Card Fail Rev. 2017 Apr;3(1):52–5.
[19] Ishaq F, Nguyen DT, Graviss EA, Ebunlomo E, Bhimaraj A, Fida N. Impact of optimal medical therapy in heart failure certification for hospitalists on guideline-directed medical therapy utilization. World J Cardiol. 2025 Jun;17(6):107102.
[20] Roghani SH, Khan DS, Shafiq A, Akbar A, Mustafa W, Shah SQA, et al. Efficacy of Different Beta Blockers in Reducing Mortality in Heart-Failure Patients. Cureus. 2024 Nov;16(11):e74171.
[21] Mitsuda H, Shiga Y, Suematsu Y, Kato Y, Arimura T, Kuwano T, et al. Effect of Angiotensin Receptor-Neprilysin Inhibitor in Patients With Heart Failure: A Real-World Study. Cardiol Res. 2025 Aug;16(4):321–30.
[22] Jhund PS, Talebi A, Henderson AD, Claggett BL, Vaduganathan M, Desai AS, et al. Mineralocorticoid receptor antagonists in heart failure: an individual patient level meta-analysis. Lancet (London, England). 2024 Sep;404(10458):1119–31.
[23] Faulkenberg K, Williams J, Isaacs D, West L. Practical Considerations and Opportunities for SGLT2 Inhibitor Prescription in Heart Failure. Curr Treat Options Cardiovasc Med. 2020 Sep 22;22:36.
[24] Fujihashi T, Nochioka K, Yasuda S, Sakata Y, Hayashi H, Shiroto T, et al. Underuse of heart failure medications and poor long-term prognosis in chronic heart failure patients with polypharmacy - A report from the CHART-2 study. Int J Cardiol Hear Vasc. 2024 Feb;50:101345.
[25] Ozasa N, Kato T, Morimoto T, Yaku H, Yamamoto E, Inuzuka Y, et al. Polypharmacy and Clinical Outcomes in Hospitalized Patients With Acute Decompensated Heart Failure. J Cardiovasc Nurs. 2023;38(1):33–43.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Nurul Kamilah Sadli, Santi Perawati, Novia Tri Astuti, Vina Neldi, Novia Tri Astuti, Marizki Pondawinata
This work is licensed under a Creative Commons Attribution 4.0 International License.
Published with license by LPPM Universitas Jambi. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International (CC BY 4.0 International). This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format, so long as attribution is given to the creator.
