Adherence to Guideline Directed Medical Therapy in Heart Failure Patients in a Tertiary Hospital in Southern Nigeria: A Real-World Experience
Dodiyi-Manuel Sotonye,
Ajala Aisha Oluwabunmi
Issue:
Volume 11, Issue 2, March 2023
Pages:
16-20
Received:
22 March 2023
Accepted:
31 March 2023
Published:
20 April 2023
Abstract: Background: There is an increase in the incidence of heart failure among the sub-Saharan population. The use of guideline-directed medical therapy has been shown not only to reduce disease progression but also frequent hospitalization, morbidity, and mortality from heart failure. This study was directed at identifying which of the major drug class for treatment of heart failure was incorporated by the physicians in the area. Methodology: The study involved collection of data from patient’s records using an observational checklist. A total of 166 heart failure patients with reduced EF were recruited between the age ranges of 33 and 95 years. The medications prescribed, date of drug initiation and progress in optimization of therapy were assessed over a 1-year period and data analyzed using SPSS version 25. A p-value of 0.05 and below was considered statistically significant. Results: The result showed that the most prevalent causes of heart failure were hypertensive heart disease (70.5%), followed by dilated cardiomyopathy (15.7%) and valvular heart disease (6.6%). The use of diuretics was prevalent among study cohorts at 87.4%, followed by Mineralocorticoid antagonist (MRAs) (78.3%), ARB/ACEI/ARNI (68.1%), beta blockers (40.4%), and less than a third of patients were on SGLT2 inhibitors (28.9%). The dosing of heart failure medications was noticed to be fixed without up-titration of doses at intervals for most classes of GDMT except the MRAs. Only about 2.4% of the study cohorts had dose optimization over this period and most study patients were not on optimal maximal doses of heart failure therapy. Conclusion: The use of guideline directed medical therapy has improved amongst HF patients however up titration of doses remains a major problem amongst patients managed in our clinic. The implementation of a multi-disciplinary HF clinic focused on improvement of outcomes of HF patient is essential in improving not only the use of Guideline- directed medical therapy (GDMT) but up-titration to optimal doses for maximal benefits.
Abstract: Background: There is an increase in the incidence of heart failure among the sub-Saharan population. The use of guideline-directed medical therapy has been shown not only to reduce disease progression but also frequent hospitalization, morbidity, and mortality from heart failure. This study was directed at identifying which of the major drug class ...
Show More
Patterns, Peculiarities and Associated Risk Factors of Anemia in Pregnancy: A Case Study of Pregnant Women Attending Antenatal Clinic in North-Central Nigeria
Azubuike Uma Inya,
Amaechi Peter Achara,
Aloysius Obinna Ikwuka,
Francis Chigozie Udeh,
Ukoma Chi-kadibia,
Ochima Onazi
Issue:
Volume 11, Issue 2, March 2023
Pages:
21-31
Received:
31 March 2023
Accepted:
19 April 2023
Published:
27 April 2023
Abstract: Background: Anemia is a prevalent medical disorder during pregnancy, posing a significant global public health burden. In developing countries like Nigeria, it remains a major cause of maternal and perinatal morbidity and mortality. Aim: To determine the red cell morphological patterns, peculiarities (clinical characteristics) of anemia, and associated risk factors including socio-demographic factors, associated with anemia among pregnant women attending antenatal clinic of a tertiary care hospital in North-Central Nigeria. Materials and Methods: A prospective, analytical study on 415 pregnant women attending antenatal clinic over a period of 4 months was conducted. The red cell morphology, Packed Cell Volume (PCV), genotype, and HIV status of each participant were determined. Using structured questionnaires, their bio-data, obstetric and medical histories, and results of routine investigations were documented. Statistical software (SPSS version 20, Chicago 11, USA) was used to analyze the data obtained. Continuous variables were presented as mean±SD, and categorical variables were presented as numbers and percentages. Chi-square tests were used for comparative analysis and the level of statistical significance was set at p<0.05. In addition, the association between anemia and socio-demographic factors, clinical characteristics, and risk factors were tested using Chi-square test. Results: Mean age of the study participants was 29.7±5.3 years. The mean BMI was 28.0±7.2 kg/m2, and the mean parity was 1.9±1.7. In addition, 7.8% of the pregnant women were HIV positive. The mean packed cell volume was 32.7±3.1%, and 42.5% of the participants were anemic, with 29.0% and 13.5% having mild and moderate anemia, respectively. The most common blood picture indicated iron deficiency anemia, with microcytic hypochromia and normocytic hypochromia. Educational level (p=0.00) and socio-economic class (p=0.00) were significantly and independently related to anemia, while gestational age (p=0.55) was not significantly related. Moreover, a history of fever during the current pregnancy was significantly related to anemia (p=0.01), while genotype (p=0.33) was not. Anemia was significantly related to HIV-positive status (p=0.00). Conclusion: Pregnant women should be encouraged to receive antenatal care, where they can receive hematinic supplements, appropriate investigations and treatments for fever or HIV. Poverty is a contributing factor to poor health outcomes during pregnancy. Implementing national and local policies to boost the economy can help alleviate poverty and improve health outcomes in pregnant women.
Abstract: Background: Anemia is a prevalent medical disorder during pregnancy, posing a significant global public health burden. In developing countries like Nigeria, it remains a major cause of maternal and perinatal morbidity and mortality. Aim: To determine the red cell morphological patterns, peculiarities (clinical characteristics) of anemia, and associ...
Show More
