{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T01:19:44Z","timestamp":1782350384690,"version":"3.54.5"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Cardiovasc Disord"],"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>To evaluate the implementation of guideline-directed medical therapy and identify associated clinical factors among patients with heart failure with reduced ejection fraction (HFrEF) receiving follow-up at Asella Referral and Teaching Hospital, Ethiopia.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>We conducted a hospital-based cross-sectional study involving 156 patients with HFrEF attending follow-up at Asella Referral and Teaching Hospital from October to December 2023. Eligible participants were adults with LVEF\u2009\u2264\u200940%, \u2265\u20096 monthly clinic visits, and a recent echocardiogram within two years. Data were collected through structured interviews and chart review and analyzed using SPSS version 26.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Prescription rates for renin-angiotensin system inhibitors (RASI), beta-blockers, and mineralocorticoid receptor antagonists (MRA) were 98.1%, 96.8%, and 70.5%, respectively. However, only 30.8% achieved target doses of RASI, 1.3% for beta-blockers, and 67.3% for MRA. Only 1.3% were on all three therapies at guideline-recommended target doses. No patient received angiotensin receptor\u2013neprilysin inhibitors (ARNI) or sodium-glucose co-transporter 2 inhibitors (SGLT2i), primarily due to cost and availability. In multivariable analysis, baseline bradycardia (adjusted odds ratio [AOR] 13.7; 95% CI 1.8\u2013100.3; <jats:italic>p<\/jats:italic>\u2009=\u20090.010) and diabetes mellitus (AOR 4.5; 95% CI 1.13\u201317.9; <jats:italic>p<\/jats:italic>\u2009=\u20090.033) were significantly associated with achieving RASI target doses. Absence of prior heart failure hospitalization was associated with a lower likelihood of achieving the MRA target dose (AOR 0.4; 95% CI 0.18\u20130.9; <jats:italic>p<\/jats:italic>\u2009=\u20090.029).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12872-025-05187-5","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T13:05:08Z","timestamp":1760015108000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Implementation of Guideline-Directed medical therapy and factors in heart failure with reduced ejection fraction"],"prefix":"10.1186","volume":"25","author":[{"given":"Firaol Wassie","family":"Bekele\u00b9","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wubshet Abraham","family":"Alemu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koricho Simie","family":"Tolla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulkadir Urgessa","family":"Jada","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengesha Akale","family":"Tekle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammedawel Kaso","family":"Adem","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassen Ahmed","family":"Yesuf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"5187_CR1","doi-asserted-by":"publisher","first-page":"678614","DOI":"10.3389\/fcvm.2021.678614","volume":"8","author":"P Li","year":"2021","unstructured":"Li P, Zhao H, Zhang J, Ning Y, Tu Y, Xu D, et al. 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(date: 20\/03\/2023, ref no. 120\/6493\/2023). To protect participant confidentiality, all collected data were anonymized, with no personal identifiers (such as names) recorded. Only relevant research information was extracted and analyzed, ensuring compliance with ethical standards for data privacy and participant rights. Written informed consent was obtained from all subjects before the study.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study maintained strict separation between clinical care and research activities. Treating physicians were not involved in data collection, analysis, or interpretation to prevent conflicts of interest. Prescription patterns were assessed solely through retrospective medical record review by trained data collectors. No therapeutic interventions were made during the study. As this study was a non-interventional study, clinical trial number was not required. The study was conducted in accordance with the principles of the Declaration of Helsinki.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"728"}}